Provider Demographics
NPI:1952803652
Name:COMFORT CARE PROVIDERS, LLC.
Entity Type:Organization
Organization Name:COMFORT CARE PROVIDERS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AZIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-383-7087
Mailing Address - Street 1:12409 W INDIAN SCHOOL RD STE A108
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-9503
Mailing Address - Country:US
Mailing Address - Phone:623-328-7087
Mailing Address - Fax:623-218-1337
Practice Address - Street 1:12409 W INDIAN SCHOOL RD STE A108
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9503
Practice Address - Country:US
Practice Address - Phone:623-328-7087
Practice Address - Fax:623-218-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ442029Medicaid