Organization
FUNDAMENTUM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN ANDAZOLA (DIRECTOR OF OPERATIONS)
(480) 450-0847
Entity
Organization
Contact information
Practice address
5830 E MCKELLIPS RD UNIT 49, MESA, AZ 85215-2784
(480) 652-6532
Mailing address
5830 E MCKELLIPS RD UNIT 49, MESA, AZ 85215-2784
(480) 652-6532
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
02/14/2024
Last updated
03/04/2024
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