Provider Demographics
NPI:1699261982
Name:CHEVICK FAMILY HOMECARE LLC
Entity type:Organization
Organization Name:CHEVICK FAMILY HOMECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:OGOTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-508-4924
Mailing Address - Street 1:600 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1247
Mailing Address - Country:US
Mailing Address - Phone:480-508-4924
Mailing Address - Fax:
Practice Address - Street 1:600 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1247
Practice Address - Country:US
Practice Address - Phone:480-508-4924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC8923251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ384745Medicaid
AZOTC8923OtherDHS LICENCE