Provider Demographics
NPI:1982120150
Name:PHOENIX AZ HEALTHCARE, INC.
Entity type:Organization
Organization Name:PHOENIX AZ HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CARLITO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALICDEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-979-6741
Mailing Address - Street 1:1825 E NORTHERN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:623-337-7480
Mailing Address - Fax:
Practice Address - Street 1:1825 E NORTHERN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:623-337-7480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health