Healthcare Provider Details

I. General information

NPI: 1063682920
Provider Name (Legal Business Name): HUALAPAI HOME HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 HUALAPAI MOUNTAIN RD SUITE B
KINGMAN AZ
86401-5493
US

IV. Provider business mailing address

2535 HUALAPAI MOUNTAIN RD SUITE B
KINGMAN AZ
86401-5493
US

V. Phone/Fax

Practice location:
  • Phone: 928-753-9015
  • Fax: 928-753-8946
Mailing address:
  • Phone: 928-753-7828
  • Fax: 928-753-8946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA4555
License Number StateAZ

VIII. Authorized Official

Name: MRS. BEVERLY MRACEK
Title or Position: DIRECTOR
Credential: RN
Phone: 928-753-9015