MEDICARE: HUDUMA CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1003486838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDUMA CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	2512 E MOBILE LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-2644
Country	:	US
Telephone Number	:	602-675-2744
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 E MOBILE LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-2644
Country	:	US
Telephone Number	:	602-675-2744
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	EVELYN JEPKEMBOI LELEI
Credential	:	STATUTORY AGENT
Telephone Number	:	323-445-2606

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	06/24/2021

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Directions to “HUDUMA CARE SERVICES LLC ” Practice Location

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