Healthcare Provider Details

I. General information

NPI: 1730469131
Provider Name (Legal Business Name): ARIZONA VISITING NURSES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2659 W GUADALUPE RD D-108
MESA AZ
85202-7254
US

IV. Provider business mailing address

2659 W GUADALUPE RD D-108
MESA AZ
85202-7254
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-0000
  • Fax: 480-775-6565
Mailing address:
  • Phone: 480-820-0000
  • Fax: 480-775-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA 5444
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberPENDING
License Number StateAZ

VIII. Authorized Official

Name: ANDRE JON MARTELL
Title or Position: PRESIDENT
Credential:
Phone: 480-313-9500