Provider Demographics
NPI:1699023846
Name:ITC PERSONAL IN-HOME CARE LLC
Entity Type:Organization
Organization Name:ITC PERSONAL IN-HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-969-5480
Mailing Address - Street 1:1345 E MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8950
Mailing Address - Country:US
Mailing Address - Phone:480-969-5480
Mailing Address - Fax:480-969-5512
Practice Address - Street 1:1345 E MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8950
Practice Address - Country:US
Practice Address - Phone:480-969-5480
Practice Address - Fax:480-969-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ479687385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child