Healthcare Provider Details

I. General information

NPI: 1013322635
Provider Name (Legal Business Name): BANNER HOME CARE-ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 E GERMANN RD STE 110W
GILBERT AZ
85297-2916
US

IV. Provider business mailing address

2901 N CENTRAL AVE STE 160
PHOENIX AZ
85012-2702
US

V. Phone/Fax

Practice location:
  • Phone: 480-657-1000
  • Fax: 480-655-2527
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: JAMES COTE
Title or Position: VP AMBULATORY
Credential:
Phone: 602-747-4000