MEDICARE: VANWARD CARE 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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1104540301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANWARD CARE LLC

Provider Business Mailing Address
First Line	:	3509 E CAMBRIDGE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-1219
Country	:	US
Telephone Number	:	815-520-4926
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 E CAMBRIDGE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-1219
Country	:	US
Telephone Number	:	815-520-4926
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN NOEL EARHART
Credential	:
Telephone Number	:	815-520-4926

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	09/30/2022

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