Provider Demographics
NPI:1982798823
Name:MERIDIAN HEALTH CARE PROVIDERS, INC
Entity Type:Organization
Organization Name:MERIDIAN HEALTH CARE PROVIDERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:KRISTIAN
Authorized Official - Last Name:DUMAGPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-857-0037
Mailing Address - Street 1:10000 N 31ST AVE STE D401
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1701
Mailing Address - Country:US
Mailing Address - Phone:480-857-0037
Mailing Address - Fax:480-857-1098
Practice Address - Street 1:10000 N 31ST AVE STE D401
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1701
Practice Address - Country:US
Practice Address - Phone:480-857-0037
Practice Address - Fax:480-857-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health