Organization
SHEPHERD HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMEON JOLLY KPA (ADMINISTRATOR)
(480) 277-8454
Entity
Organization
Contact information
Practice address
7702 N 35TH AVE RM 3, PHOENIX, AZ 85051-6508
(623) 268-2542
Mailing address
7702 N 35TH AVE RM 3, PHOENIX, AZ 85051-6508
(623) 268-2542
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
12/22/2022
Last updated
12/22/2022
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