Healthcare Provider Details

I. General information

NPI: 1790143097
Provider Name (Legal Business Name): V A HOME HEALTH 1 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6718 W GREENWAY RD SUITE 208
PEORIA AZ
85381-4583
US

IV. Provider business mailing address

6710 N 47TH AVE SUITE 8
GLENDALE AZ
85301-4111
US

V. Phone/Fax

Practice location:
  • Phone: 844-824-3577
  • Fax: 844-329-8682
Mailing address:
  • Phone: 844-824-3577
  • Fax: 844-329-8682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA6215
License Number StateAZ

VIII. Authorized Official

Name: ARMEN GHADIMIAN
Title or Position: CEO
Credential:
Phone: 844-824-3577