Provider Demographics
NPI:1306156864
Name:FIRST CLASS HOME CARE, LLC
Entity type:Organization
Organization Name:FIRST CLASS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAZAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-368-9391
Mailing Address - Street 1:405 W CAMPO BELLO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6533
Mailing Address - Country:US
Mailing Address - Phone:602-368-9391
Mailing Address - Fax:602-993-0534
Practice Address - Street 1:405 W CAMPO BELLO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6533
Practice Address - Country:US
Practice Address - Phone:602-368-9391
Practice Address - Fax:602-993-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ515494Medicaid