Healthcare Provider Details

I. General information

NPI: 1619085289
Provider Name (Legal Business Name): HERITAGE HOME HEALTH CARE OF ARIZONIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 US HIGHWAY 60 SUITE J
MIAMI AZ
85539-7715
US

IV. Provider business mailing address

8212 LOUISIANA BLVD NE
ALBUQUERQUE NM
87113-2105
US

V. Phone/Fax

Practice location:
  • Phone: 928-402-0060
  • Fax: 928-402-0080
Mailing address:
  • Phone: 505-796-3200
  • Fax: 505-796-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA4002
License Number StateAZ

VIII. Authorized Official

Name: STEVE BOURNE
Title or Position: CFO
Credential:
Phone: 505-796-3236