MEDICARE: ASSURE HEALTH CARE GROUP OF ARIZONA, 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	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care

General Provider Information

NPI Number	:	1790324606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSURE HEALTH CARE GROUP OF ARIZONA, LLC

Provider Business Mailing Address
First Line	:	4682 W OAKLAND ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-2924
Country	:	US
Telephone Number	:	480-318-5076
Fax Number	:

Provider Business Practice Location Address
First Line	:	4682 W OAKLAND ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-2924
Country	:	US
Telephone Number	:	480-318-5076
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. REBECA LOPEZ
Credential	:
Telephone Number	:	480-318-5076

Provider Enumeration Date	:	12/26/2019
Last Update Date	:	12/26/2019

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