MEDICARE: IMANI HOME CARE LIVING 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1700401957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMANI HOME CARE LIVING LLC

Provider Business Mailing Address
First Line	:	4425 W OLIVE AVE STE 144
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-3844
Country	:	US
Telephone Number	:	623-230-2464
Fax Number	:

Provider Business Practice Location Address
First Line	:	8539 W HAZELWOOD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-1534
Country	:	US
Telephone Number	:	480-276-8277
Fax Number	:	866-837-9226

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	PATRICK MASOYA
Credential	:
Telephone Number	:	480-276-8277

Provider Enumeration Date	:	06/13/2020
Last Update Date	:	09/11/2023

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Directions to “IMANI HOME CARE LIVING LLC ” Practice Location

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