Healthcare Provider Details

I. General information

NPI: 1447277264
Provider Name (Legal Business Name): STATESERV HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 05/15/2025
Certification Date: 02/17/2020
Deactivation Date: 10/23/2019
Reactivation Date: 02/17/2020

III. Provider practice location address

1201 S. ALMA SCHOOL RD SUITE 4000
MESA AZ
85210
US

IV. Provider business mailing address

1201 S. ALMA SCHOOL RD. SUITE 4000
MESA AZ
85210
US

V. Phone/Fax

Practice location:
  • Phone: 480-797-8061
  • Fax: 866-280-0415
Mailing address:
  • Phone: 877-633-7250
  • Fax: 866-280-0415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. CHRISTOPHER ROODE
Title or Position: COO
Credential:
Phone: 877-633-7250