Provider Demographics
NPI:1689448979
Name:TOTAL SUPPORT HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:TOTAL SUPPORT HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IKECHUKWU 'IKE'
Authorized Official - Middle Name:
Authorized Official - Last Name:IGBOKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-419-4001
Mailing Address - Street 1:12387 W GLENROSA AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4287
Mailing Address - Country:US
Mailing Address - Phone:623-419-4001
Mailing Address - Fax:
Practice Address - Street 1:12387 W GLENROSA AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4287
Practice Address - Country:US
Practice Address - Phone:623-419-4001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities