Healthcare Provider Details

I. General information

NPI: 1548529373
Provider Name (Legal Business Name): ARIZONA SENIOR HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 HIGHWAY 60 STE 103
MIAMI AZ
85539-8731
US

IV. Provider business mailing address

2105 HIGHWAY 60 STE 103
MIAMI AZ
85539-8731
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-4663
  • Fax: 800-832-9131
Mailing address:
  • Phone: 928-425-4663
  • Fax: 800-832-9131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LISA ELLEN KENNEDY
Title or Position: CEO
Credential:
Phone: 928-853-4486