Individual
TINA MARIE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4657 E ODESSA DR, QUEEN CREEK, AZ 85140-4516
(951) 305-1462
Mailing address
4657 E ODESSA DR, QUEEN CREEK, AZ 85140-4516
(951) 305-1462
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88-07544070
IN HOME CARE FOR ELDERLY
AZ
Enumeration date
12/02/2022
Last updated
12/02/2022
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