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General NPI Number Information
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NPI Number | 1760262950
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Entity Type | Organization
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Legal Business Name | MOMBA HOME CARE ARIZONA LLC
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Dates
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Enumeration Date | 10/04/2023
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 1300 S LITCHFIELD RD STE 115D
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City | GOODYEAR
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State | AZ
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Zip | 85338-1645
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Country | US
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Telephone | 520-829-0535
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Fax |
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Provider Business Mailing Address
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Address Line | 5565 GLENRIDGE CONNECTOR STE 500
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City | SANDY SPRINGS
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State | GA
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Zip | 30342-4796
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Country | US
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Telephone | 404-962-1033
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Fax |
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Authorized Official
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Title or Position | NPI MANAGER
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Name | ELAZAR HUISMAN
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Credential |
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Telephone | 404-418-7484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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