MEDICARE: SISISELA FRIENDLY HOME CARE

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	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1235092313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SISISELA FRIENDLY HOME CARE

Provider Business Mailing Address
First Line	:	6144 E MINTON PL
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1516
Country	:	US
Telephone Number	:	480-453-4619
Fax Number	:

Provider Business Practice Location Address
First Line	:	3056 E KRAMER ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-3110
Country	:	US
Telephone Number	:	480-453-4619
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LUISA P FAINU
Credential	:
Telephone Number	:	480-453-4619

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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