Healthcare Provider Details

I. General information

NPI: 1215350038
Provider Name (Legal Business Name): COMPANION HOME HEALTH OF MARICOPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 S ALMA SCHOOL RD SUITE A-105, OFFICE NO. 8
MESA AZ
85210-3064
US

IV. Provider business mailing address

1930 S ALMA SCHOOL RD SUITE A-105, OFFICE NO. 8
MESA AZ
85210-3064
US

V. Phone/Fax

Practice location:
  • Phone: 866-270-0356
  • Fax: 866-230-5692
Mailing address:
  • Phone: 866-270-0356
  • Fax: 866-230-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. SUSAN TSCHUDY
Title or Position: AREA MANAGER
Credential: RN
Phone: 866-270-0356