Healthcare Provider Details

I. General information

NPI: 1548932395
Provider Name (Legal Business Name): NEW HORIZON HOME HEALTHCARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21404 N VAN LOO DR
MARICOPA AZ
85138-8661
US

IV. Provider business mailing address

21404 N VAN LOO DR
MARICOPA AZ
85138-8661
US

V. Phone/Fax

Practice location:
  • Phone: 414-629-7061
  • Fax:
Mailing address:
  • Phone: 414-629-7061
  • 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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. TISHA NICOLE ANDERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 414-629-7061