MEDICARE: LAVISH HOME CARE LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251G00000X	Community Based Hospice Care Agency
2	251J00000X	Nursing Care Agency
3	253Z00000X	In Home Supportive Care Agency
4	343900000X	Non-emergency Medical Transport (VAN)
5	385H00000X	Respite Care
6	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1164177408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAVISH HOME CARE LLC.

Provider Business Mailing Address
First Line	:	1460 E BELL RD APT 2146-2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-7794
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1460 E BELL RD APT 2146-2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-7794
Country	:	US
Telephone Number	:	480-599-7980
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	TIMEREA DUNN
Credential	:	LPN
Telephone Number	:	480-599-7980

Provider Enumeration Date	:	02/15/2022
Last Update Date	:	03/08/2024

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