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MR. JERRY LEE BEGAY
>> Chore Provider >> Nursing Service Related ProvidersRegistrant NPI Number: 1750506382
Individual Registrant:MR. JERRY LEE BEGAY
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
2.5 MI WEST MP 0 NAVAJO ROUTE 5 INDIAN WELL, AZ 86031-0636 US
Tel: 602-363-4901 Fax: --
Tel: 602-363-4901 Fax: --
Contact information for business:
PO BOX 636 HOLBROOK, AZ 86025-0636 US
Tel: 602-363-4901 Fax: --
Tel: 602-363-4901 Fax: --
Registration Information:
NPI: 1750506382
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| X | 372500000X | Nursing Service Related Providers Chore Provider | ||
| X | 372600000X | Nursing Service Related Providers Adult Companion | ||
| X | 3747A0650X | Nursing Service Related Providers Technician | ||
| X | 3747P1801X | Nursing Service Related Providers Technician | ||
| X | 374U00000X | Nursing Service Related Providers Home Health Aide | ||
| X | 376J00000X | Nursing Service Related Providers Homemaker |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| AHCCCS PROVIDER ID NUMBER | 630203 | AZ | 01 |
