| Md Homecare Llc | |
|
9225 N 3rd St Ste 102 Phoenix AZ 85020-2455 | |
| (602) 362-2983 | |
| (480) 565-4552 |
| Full Name | Md Homecare Llc |
|---|---|
| Speciality | Psychologist |
| Location | 9225 N 3rd St Ste 102, Phoenix, Arizona |
| Authorized Official Name and Position | Mohamed Khalil (CEO) |
| Authorized Official Contact | 6023622983 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Md Homecare Llc 9225 N 3rd St Ste 102 Phoenix AZ 85020-2455 Ph: (602) 362-2983 | Md Homecare Llc 9225 N 3rd St Ste 102 Phoenix AZ 85020-2455 Ph: (602) 362-2983 |
| NPI Number | 1720524333 |
|---|---|
| Provider Enumeration Date | 01/06/2017 |
| Last Update Date | 07/05/2023 |
| Certification Date | 07/05/2023 |
| Medicare PECOS PAC ID | 8325324114 |
|---|---|
| Medicare Enrollment ID | O20170410001831 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720524333 | NPI | - | NPPES |
| 1720524333 | Other | AZ | NPI |
| 290653 | Medicaid | AZ |
| Provider Name | John D Lewis |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1255386413 PECOS PAC ID: 2769440643 Enrollment ID: I20041222000869 |
| Provider Name | Raul J Rodriguez Sora |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811097538 PECOS PAC ID: 2961420088 Enrollment ID: I20051108000186 |
| Provider Name | Jason P Heavens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063781797 PECOS PAC ID: 3375799810 Enrollment ID: I20120815000744 |
| Provider Name | Nicole Kay Larsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265918726 PECOS PAC ID: 5193065910 Enrollment ID: I20190314000187 |
| Provider Name | Jasmine Hope Cresanta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386273688 PECOS PAC ID: 4789014556 Enrollment ID: I20200417002251 |
| Provider Name | Theresa Jill Fryer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871917161 PECOS PAC ID: 9537581160 Enrollment ID: I20200626001193 |
| Provider Name | Meta Alpha Galabe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598366767 PECOS PAC ID: 6103229836 Enrollment ID: I20210719002855 |
| Provider Name | Chinasa Veney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629709886 PECOS PAC ID: 5991173429 Enrollment ID: I20221115000643 |
| Provider Name | Mandeep K Sidhu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003538844 PECOS PAC ID: 6800265265 Enrollment ID: I20221207002781 |
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