Healthcare Provider Details

I. General information

NPI: 1649705765
Provider Name (Legal Business Name): ESTRELLA HOME HEALTH CARE 2, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 E NORTHERN AVE STE C101
PHOENIX AZ
85028-4839
US

IV. Provider business mailing address

2990 E NORTHERN AVE STE C101
PHOENIX AZ
85028-4839
US

V. Phone/Fax

Practice location:
  • Phone: 623-792-7282
  • Fax: 623-792-7720
Mailing address:
  • Phone: 623-792-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: WENDEL ADRAIN AKINS
Title or Position: DIRECTOR OF NURSING
Credential:
Phone: 623-792-7282