Provider Demographics
NPI:1447045471
Name:FLAGSTONE HEALTHCARE IV
Entity type:Organization
Organization Name:FLAGSTONE HEALTHCARE IV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:818-585-0564
Mailing Address - Street 1:2655 W GUADALUPE RD STE 18
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7246
Mailing Address - Country:US
Mailing Address - Phone:480-777-0070
Mailing Address - Fax:480-777-0072
Practice Address - Street 1:2655 W GUADALUPE RD STE 18
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7246
Practice Address - Country:US
Practice Address - Phone:480-777-0070
Practice Address - Fax:480-777-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care