Provider Demographics
NPI:1407665953
Name:FLAGSTONE HEALTHCARE I, LLC
Entity type:Organization
Organization Name:FLAGSTONE HEALTHCARE I, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:COITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-594-0819
Mailing Address - Street 1:15655 W ROOSEVELT ST STE 104
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9311
Mailing Address - Country:US
Mailing Address - Phone:623-594-0819
Mailing Address - Fax:623-218-1323
Practice Address - Street 1:15655 W ROOSEVELT ST STE 104
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9311
Practice Address - Country:US
Practice Address - Phone:623-594-0819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care