Individual
SAO BRIMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11615 W HACKBARTH DR, YOUNGTOWN, AZ 85363-1746
(480) 207-8904
Mailing address
11615 W HACKBARTH DR, YOUNGTOWN, AZ 85363-1746
(480) 207-8904
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
374U00000X
Home Health Aide
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
Other
Enumeration date
10/21/2021
Last updated
01/31/2022
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