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General NPI Number Information
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NPI Number | 1881487585
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Entity Type | Organization
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Legal Business Name | MICAH 6:8, LLC
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Dates
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Enumeration Date | 05/26/2025
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 225 E SHADOW RDG
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City | COTTONWOOD
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State | AZ
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Zip | 86326-2841
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Country | US
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Telephone | 928-340-6690
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Fax |
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Provider Business Mailing Address
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Address Line | 989 S MAIN ST STE A-435
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4601
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Country | US
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Telephone | 928-340-6690
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WILLIAM CLARK
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Credential |
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Telephone | 928-340-6690
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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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