Provider Demographics
NPI:1235453671
Name:VALLEY CARE & ENRICHMENT SERVICES, INC
Entity Type:Organization
Organization Name:VALLEY CARE & ENRICHMENT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABDELRAHIM
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:ABDELRAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-697-0429
Mailing Address - Street 1:2559 W TAMARISK AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-2041
Mailing Address - Country:US
Mailing Address - Phone:602-697-0429
Mailing Address - Fax:
Practice Address - Street 1:2559 W TAMARISK AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-2041
Practice Address - Country:US
Practice Address - Phone:602-697-0429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ478952343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ478952OtherAHCCCS