Provider Demographics
NPI:1174294482
Name:ULTIMATE TOUCHUP LLC
Entity Type:Organization
Organization Name:ULTIMATE TOUCHUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADJEI
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:480-812-3680
Mailing Address - Street 1:214 W DANISH RED TRL
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5517
Mailing Address - Country:US
Mailing Address - Phone:480-812-3680
Mailing Address - Fax:
Practice Address - Street 1:214 W DANISH RED TRL
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5517
Practice Address - Country:US
Practice Address - Phone:480-812-3680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ098234Medicaid