Healthcare Provider Details

I. General information

NPI: 1912504358
Provider Name (Legal Business Name): SUNFLOWERS HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 MESQUITE AVE UNIT 1
LAKE HAVASU CITY AZ
86403
US

IV. Provider business mailing address

1989 MESQUITE AVE UNIT 1
LAKE HAVASU CITY AZ
86403
US

V. Phone/Fax

Practice location:
  • Phone: 928-208-6100
  • Fax:
Mailing address:
  • Phone: 928-208-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MERCEDES EVELYN HAILE
Title or Position: SOLE MBR
Credential:
Phone: 928-208-6100