Provider Demographics
NPI:1164642393
Name:PRIVATE NURSING, INC.
Entity Type:Organization
Organization Name:PRIVATE NURSING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YISHAI
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-612-5672
Mailing Address - Street 1:2405 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 8-9
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7611
Mailing Address - Country:US
Mailing Address - Phone:480-755-8888
Mailing Address - Fax:480-730-9797
Practice Address - Street 1:2405 E. SOUTHERN AVE.
Practice Address - Street 2:SUITE 8-9
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-755-8888
Practice Address - Fax:480-730-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
03-7403OtherCMS CERTIFICATION NUMBER