Provider Demographics
NPI:1255662458
Name:FELICITY HOME CARE LLC
Entity Type:Organization
Organization Name:FELICITY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-776-6096
Mailing Address - Street 1:1237 S VAL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6401
Mailing Address - Country:US
Mailing Address - Phone:480-776-6096
Mailing Address - Fax:480-719-4445
Practice Address - Street 1:1237 S VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6401
Practice Address - Country:US
Practice Address - Phone:480-776-6096
Practice Address - Fax:480-719-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ492933Medicaid