MEDICARE: NECKUP CHECKUP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	405300000X	Prevention Professional
2	171M00000X	Case Manager/Care Coordinator
3	172V00000X	Community Health Worker
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1538850268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NECKUP CHECKUP

Provider Business Mailing Address
First Line	:	2030 W BASELINE RD # 182-150
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6574
Country	:	US
Telephone Number	:	480-227-6984
Fax Number	:

Provider Business Practice Location Address
First Line	:	5130 E WARNER RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-3363
Country	:	US
Telephone Number	:	480-227-6984
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JORONDA AISHA MONTANO
Credential	:	MPA
Telephone Number	:	480-227-6984

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	05/15/2023

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Directions to “NECKUP CHECKUP ” Practice Location

Language	Start Address	Practice Location

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