Provider Demographics
NPI:1619597218
Name:EAST VALLEY SENIOR CARE, LLC
Entity Type:Organization
Organization Name:EAST VALLEY SENIOR CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SKELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-315-3954
Mailing Address - Street 1:600 E BASELINE RD STE A-1
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1265
Mailing Address - Country:US
Mailing Address - Phone:480-745-2493
Mailing Address - Fax:
Practice Address - Street 1:600 E BASELINE RD STE A-1
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1265
Practice Address - Country:US
Practice Address - Phone:480-745-2493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care