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General NPI Number Information
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NPI Number | 1790256535
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Entity Type | Organization
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Legal Business Name | GWEN'S ADVANCE CARE
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 1635 E BASELINE RD STE 109
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City | PHOENIX
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State | AZ
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Zip | 85042-6891
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Country | US
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Telephone | 602-595-5707
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Fax | 602-595-7147
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Provider Business Mailing Address
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Address Line | 1635 E BASELINE RD STE 109
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City | PHOENIX
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State | AZ
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Zip | 85042-6891
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Country | US
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Telephone | 602-595-5707
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Fax | 602-595-7147
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Authorized Official
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Title or Position | CARE COORDINATOR
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Name | VALERIE JOLINE LOPEZ
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Credential | RN, BSN
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Telephone | 602-595-5707
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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 |
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