Organization
GRAND CANYON HOME CARE INC.
Active
Organization
GRAND CANYON HOME CARE INC.
Active
Parent organization
GRAND CANYON HOME CARE
Other names
grand canyon home care - MESA
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRAND CANYON HOME CARE
Authorized official
YAKOV YUSHUVAYEV (PRESIDENT)
(907) 222-7666
Entity
Organization
Contact information
Practice address
420 E SOUTHERN AVE STE 110A, MESA, AZ 85204-4945
(480) 397-6010
Mailing address
13201 N 35TH AVE STE 4B, PHOENIX, AZ 85029-1231
(602) 795-0222
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
568006
—
AZ
Enumeration date
07/30/2018
Last updated
07/30/2018
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