Healthcare Provider Details

I. General information

NPI: 1437527835
Provider Name (Legal Business Name): ABODE HOME HEALTH ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 N CENTRAL AVE STE 1220
PHOENIX AZ
85012-2105
US

IV. Provider business mailing address

3550 N CENTRAL AVE STE 1200
PHOENIX AZ
85012-2111
US

V. Phone/Fax

Practice location:
  • Phone: 602-714-1410
  • Fax:
Mailing address:
  • Phone: 206-714-1410
  • Fax:

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: MR. DAVID KOSLOFF
Title or Position: CFO
Credential:
Phone: 206-576-0087