Provider Demographics
NPI:1376908996
Name:WESTCHESTER TBI HOME CARE LLC
Entity Type:Organization
Organization Name:WESTCHESTER TBI HOME CARE LLC
Other - Org Name:TEMPE TBI HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:SAMANTHA
Authorized Official - Last Name:QENDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-275-2221
Mailing Address - Street 1:1046 E WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3039
Mailing Address - Country:US
Mailing Address - Phone:480-275-2221
Mailing Address - Fax:480-361-6471
Practice Address - Street 1:1046 E WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3039
Practice Address - Country:US
Practice Address - Phone:480-275-2221
Practice Address - Fax:480-361-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-25
Last Update Date:2015-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9833H305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service