Provider Demographics
NPI:1669299715
Name:EHMANN, THOMAS CHARLES
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CHARLES
Last Name:EHMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12440 N 20TH ST APT 206
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5888
Mailing Address - Country:US
Mailing Address - Phone:602-369-7444
Mailing Address - Fax:
Practice Address - Street 1:12440 N 20TH ST APT 206
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5888
Practice Address - Country:US
Practice Address - Phone:602-369-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385HR2060X, 385HR2065X, 385HR2055X, 385H00000X
AZB11092322344600000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No344600000XTransportation ServicesTaxi
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child