Healthcare Provider Details

I. General information

NPI: 1255172029
Provider Name (Legal Business Name): VALLEY RESPITE AND HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5640 W TRENTON WAY
FLORENCE AZ
85132-1318
US

IV. Provider business mailing address

5640 W TRENTON WAY
FLORENCE AZ
85132-1318
US

V. Phone/Fax

Practice location:
  • Phone: 520-340-4246
  • Fax: 520-340-4254
Mailing address:
  • Phone: 520-340-4246
  • Fax: 520-340-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA SIARA
Title or Position: MANAGER
Credential:
Phone: 520-340-4246