Provider Demographics
NPI:1265947980
Name:CPLC HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:CPLC HOME HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOME HEALTHCARE
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-442-9548
Mailing Address - Street 1:1617 N 45TH AVE APT A102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85035-4220
Mailing Address - Country:US
Mailing Address - Phone:602-442-9548
Mailing Address - Fax:602-269-0621
Practice Address - Street 1:1617 N 45TH AVE APT A102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-4220
Practice Address - Country:US
Practice Address - Phone:602-442-9548
Practice Address - Fax:602-269-0621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CPLC HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-04
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health