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General NPI Number Information
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NPI Number | 1558857318
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Entity Type | Organization
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Legal Business Name | DESPAIN SENIOR CARE LLC
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 17100 E SHEA BLVD STE 530
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-6661
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Country | US
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Telephone | 480-500-6550
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Fax | 480-664-4295
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Provider Business Mailing Address
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Address Line | 17100 E SHEA BLVD STE 530
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-6661
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Country | US
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Telephone | 480-500-6550
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Fax | 480-664-4295
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Authorized Official
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Title or Position | OWNER
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Name | MARTIN DESPAIN
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Credential |
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Telephone | 480-500-6550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | AZ
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