Healthcare Provider Details

I. General information

NPI: 1295137362
Provider Name (Legal Business Name): ARIZONA SELECT HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2014
Last Update Date: 02/03/2024
Certification Date: 02/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 W CACTUS RD STE A19
PEORIA AZ
85381-9534
US

IV. Provider business mailing address

7440 W CACTUS RD STE A19
PEORIA AZ
85381-9534
US

V. Phone/Fax

Practice location:
  • Phone: 480-428-3526
  • Fax: 480-428-3545
Mailing address:
  • Phone: 480-428-3526
  • Fax: 480-428-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberHHA6895
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberHHA6895
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberHHA6895
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberHHA6895
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberHHA6895
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberHHA6895
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberHHA6895
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberHHA6895
License Number StateAZ
# 9
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA6895
License Number StateAZ
# 10
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberHHA6895
License Number StateAZ
# 11
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHHA6895
License Number StateAZ
# 12
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 13
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHHA6895
License Number StateAZ
# 14
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA6895
License Number StateAZ
# 15
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberHHA6895
License Number StateAZ

VIII. Authorized Official

Name: LAYTH JARULLAH
Title or Position: CEO
Credential:
Phone: 480-428-3526