Provider Demographics
NPI:1457004194
Name:CONVERGENCE CARE LLC
Entity Type:Organization
Organization Name:CONVERGENCE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-971-1324
Mailing Address - Street 1:2959 N SWAN RD STE 161
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1232
Mailing Address - Country:US
Mailing Address - Phone:520-971-1324
Mailing Address - Fax:
Practice Address - Street 1:2959 N SWAN RD STE 161
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1232
Practice Address - Country:US
Practice Address - Phone:520-971-1324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21426545OtherTRANSACTION PRIVILEGE TAX LICENSE