Healthcare Provider Details

I. General information

NPI: 1669826673
Provider Name (Legal Business Name): ARIZONA SENIOR HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 SUNSET PT STE A
MIAMI AZ
85539-1347
US

IV. Provider business mailing address

2123 SUNSET PT STE A
MIAMI AZ
85539-1347
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 NumberHHA5649
License Number StateAZ

VIII. Authorized Official

Name: MELLISA MARIE TAYLOR
Title or Position: DIRECTOR OF NURSING
Credential: D.O.N
Phone: 928-425-4663