Healthcare Provider Details

I. General information

NPI: 1356708655
Provider Name (Legal Business Name): HOME HEALTH SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19375 E. OASIS
BLACK CANYON CITY AZ
85324
US

IV. Provider business mailing address

3628 W AIDAN LN
ANTHEM AZ
85086-3773
US

V. Phone/Fax

Practice location:
  • Phone: 623-363-8691
  • Fax:
Mailing address:
  • Phone: 623-363-8691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3297
License Number StateAZ

VIII. Authorized Official

Name: MR. GREGG WESLEY POTTER
Title or Position: LICENSED PHYSICAL THERAPIST
Credential: P.T.
Phone: 623-363-8691