Healthcare Provider Details

I. General information

NPI: 1992057525
Provider Name (Legal Business Name): LOS NINOS INNOVATIVE HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E THOMAS RD SUITE 230
PHOENIX AZ
85016-8221
US

IV. Provider business mailing address

1402 E SOUTH MOUNTAIN AVE
PHOENIX AZ
85042-7925
US

V. Phone/Fax

Practice location:
  • Phone: 602-305-9500
  • Fax: 602-305-9501
Mailing address:
  • Phone: 602-243-4231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberLP034892
License Number StateAZ

VIII. Authorized Official

Name: PAULINE J ZAUTKE
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 602-305-9500