GRAND CANYON HOME CARE INC. (NPI# 1295213544) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295213544 |
| Entity Type | Organization |
| Organization Name | GRAND CANYON HOME CARE INC. |
| Other Organization Name | GRAND CANYON HOME CARE - MESA |
| Practice Address |
420 E Southern Ave Ste 110a Mesa AZ 85204-4945 |
| Mailing Address |
13201 N 35th Ave Ste 4b Phoenix AZ 85029-1231 |
| Practice Telephone | 4803976010 |
| Mailing Telephone | 6027950222 |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2018-07-30 |
| Authorized Official Name | YAKOV YUSHUVAYEV (PRESIDENT) |
| Authorized Official Telephone | 9072227666 |
| Is Organization Subpart | Y |
| Parent Organization Name | GRAND CANYON HOME CARE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3747A0650X |
Technician Specialization: Attendant Care Provider |
Nursing Service Related Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 568006 | 05 |
| Other Name | Type Code |
|---|---|
| grand canyon home care - MESA | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972805679 | Grand Canyon Home Care Inc. | Technician | 13201 N 35th Ave Ste 15b, Phoenix, AZ 85029-1232 | 2010-12-01 |
| Street Address |
420 E SOUTHERN AVE STE 110A |
| City | MESA |
| State | AZ |
| Zip Code | 85204-4945 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225516578 | Yakov Yushuvayev | Technician | 420 E Southern Ave Ste 110a, Mesa, AZ 85204-4945 | 2018-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194374819 | Luminations Healing Center, LLC | Social Worker | 1237 S. Val Vista Dr. #221, Mesa, AZ 85204 | 2019-09-05 |
| 1881160356 | Wanjiru Landers | Student in an Organized Health Care Education/Training Program | 550 S Linda Circle, Mesa, AZ 85204 | 2018-10-22 |
| 1649754235 | Adam Desnous | Specialist/Technologist | 751 S Daley, Mesa, AZ 85204 | 2018-09-19 |
| 1982128187 | Michael Anthony Jones | Counselor | 1107 North Gilbert Rd, Mesa, AZ 85204 | 2017-07-29 |
| 1295287225 | Scottsdale Healthcare Corp | Family Medicine | 2530 W. Southern Ave, Mesa, AZ 85204 | 2016-10-25 |
| 1427504158 | Richard White | Physician Assistant | 2345 E Southern Ave # 101, Mesa, AZ 85204 | 2016-09-01 |
| 1548716780 | Pain Stop Accident Injury LLC | Chiropractor | 425 E 11th Ave, Mesa, AZ 85204 | 2016-08-28 |
| 1154704252 | Glenn Taylor Lesueur | Dentist | 1056 S. Val Vista Dr., Suite 1, Mesa, AZ 85204 | 2015-07-07 |
| 1073932513 | Naomi Devine | Nurse Practitioner | 1840 South Stapley Drive, Suite 101, Mesa, AZ 85204 | 2014-04-14 |
| 1609292531 | John Kamau | Counselor | 1060 S Lobin Ln, Mesa, AZ 85204 | 2014-03-17 |
| Find all providers in zip 85204 | ||||
| Taxonomy Code | 3747A0650X |
| Grouping | Nursing Service Related Providers |
| Classification | Technician |
| Specialization | Attendant Care Provider |
| An individual who provides hands-on care, of both a supportive and health related nature, specific to the needs of a medically stable, physically handicapped individual. Supportive services are those that substitute for the absence, loss, diminution, or impairment of a physical or cognitive function. This service may include skilled or nursing care to the extent permitted by state law. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770191181 | Valerie Ann Beuschlein | Technician | 1507 N Sterling, Mesa, AZ 85207-3830 | 2020-07-21 |
| 1487292173 | Amber P Bradshaw | Technician | 2855 S Extension Rd Unit 259, Mesa, AZ 85210-8282 | 2019-12-13 |
| 1982255089 | Wendy Clement | Technician | 2219 S El Marino, Mesa, AZ 85202-6471 | 2019-09-20 |
| 1891343760 | Dionne Nick | Technician | 4135 E Crescent Ave, Mesa, AZ 85206-1950 | 2019-09-03 |
| 1962050211 | Ruby Evans | Technician | 11332 E Solina Cir, Mesa, AZ 85212-7038 | 2019-08-29 |
| 1306494794 | Joann Domzalski | Technician | 857 E 8th Pl, Mesa, AZ 85203-5605 | 2019-08-28 |
| 1043867351 | Michelle Guy | Technician | 10452 E Irwin Cir, Mesa, AZ 85209-7722 | 2019-08-21 |
| 1952967788 | Janice Marie Armstrong | Technician | 461 N Yucca Cir, Mesa, AZ 85201-4551 | 2019-05-16 |
| 1225516578 | Yakov Yushuvayev | Technician | 420 E Southern Ave Ste 110a, Mesa, AZ 85204-4945 | 2018-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538760525 | Ayomikun Ajulo | Technician | 7426 W Cheryl Dr, Peoria, AZ 85345-6723 | 2020-11-05 |
| 1306458609 | Tammy Kloser | Technician | 21738 N 91st Ln, Peoria, AZ 85382-8345 | 2020-08-18 |
| 1669090114 | Rogers K Bagia | Technician | 3141 W Maldonado Rd, Phoenix, AZ 85041-6372 | 2020-07-10 |
| 1780201087 | Jovanna A Noriega | Technician | 4533 E Rolling Ridge Rd, San Tan Valley, AZ 85140-9576 | 2020-07-02 |
| 1689291320 | Andrew Young | Technician | 9980 N Hacienda Hermosa Dr, Tucson, AZ 85737-3645 | 2020-06-29 |
| 1730706730 | Shindona Duffey | Technician | 16069 W Sierra St, Goodyear, AZ 85338-3575 | 2020-06-25 |
| 1679197883 | Amanda Lee Pethers | Technician | 13820 S 44th St Apt 1129, Phoenix, AZ 85044-4857 | 2020-06-03 |
| 1063049385 | Natacha Clerfond | Technician | 5728 N 67th Dr, Glendale, AZ 85303-4902 | 2020-03-25 |
| 1376177410 | Jo Ann Chavez | Technician | 13561 N Sandra Rd, Marana, AZ 85658-4132 | 2020-02-27 |
| 1639701170 | Penelope Thompson | Technician | 1728 W Elm St, Phoenix, AZ 85015-3865 | 2020-02-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.