Provider Demographics
NPI:1720524333
Name:MD HOMECARE LLC
Entity Type:Organization
Organization Name:MD HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-362-2983
Mailing Address - Street 1:9225 N 3RD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2455
Mailing Address - Country:US
Mailing Address - Phone:602-362-2983
Mailing Address - Fax:480-565-4552
Practice Address - Street 1:9225 N 3RD ST STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2455
Practice Address - Country:US
Practice Address - Phone:602-362-2983
Practice Address - Fax:480-565-4552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MD HOMECARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-06
Last Update Date:2023-07-05
Deactivation Date:2023-06-02
Deactivation Code:
Reactivation Date:2023-07-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1720524333OtherNPI
AZ290653Medicaid