MEDICARE: ABODE HOME HEALTH ARIZONA, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1437527835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABODE HOME HEALTH ARIZONA, LLC

Provider Business Mailing Address
First Line	:	3550 N CENTRAL AVE STE 1200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2111
Country	:	US
Telephone Number	:	206-714-1410
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 N CENTRAL AVE STE 1220
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2105
Country	:	US
Telephone Number	:	602-714-1410
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. DAVID KOSLOFF
Credential	:
Telephone Number	:	206-576-0087

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	01/04/2018

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