MEDICARE: TUMBLEWEED CLUB, 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	332U00000X	Home Delivered Meals
2	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1275377483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUMBLEWEED CLUB, LLC

Provider Business Mailing Address
First Line	:	13210 W VAN BUREN ST STE 112
Second Line	:
City	:	GOODYEAR
State	:	AZ
Zip	:	85338-1164
Country	:	US
Telephone Number	:	623-300-2858
Fax Number	:

Provider Business Practice Location Address
First Line	:	13210 W VAN BUREN ST STE 112
Second Line	:
City	:	GOODYEAR
State	:	AZ
Zip	:	85338-1164
Country	:	US
Telephone Number	:	623-300-2858
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEREMY JOSEPOH CLARIDGE
Credential	:
Telephone Number	:	623-246-1000

Provider Enumeration Date	:	06/21/2024
Last Update Date	:	06/21/2024

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Directions to “TUMBLEWEED CLUB, LLC ” Practice Location

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