Provider Demographics
NPI:1821444894
Name:CHP CARE, PC
Entity Type:Organization
Organization Name:CHP CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-708-8455
Mailing Address - Street 1:25812 N 67TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7135
Mailing Address - Country:US
Mailing Address - Phone:602-332-3363
Mailing Address - Fax:
Practice Address - Street 1:25812 N 67TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-7135
Practice Address - Country:US
Practice Address - Phone:602-332-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty