Provider Demographics
NPI:1619696747
Name:CHERISHED MOMENTS HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:CHERISHED MOMENTS HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:D'AMITRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-213-0468
Mailing Address - Street 1:4350 W CAMELBACK RD # 1038
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-7606
Mailing Address - Country:US
Mailing Address - Phone:559-213-0468
Mailing Address - Fax:
Practice Address - Street 1:13621 W GLENDALE AVE
Practice Address - Street 2:UNIT 1126
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85307
Practice Address - Country:US
Practice Address - Phone:559-213-0468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No332U00000XSuppliersHome Delivered Meals
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child