Healthcare Provider Details

I. General information

NPI: 1801753314
Provider Name (Legal Business Name): GEORGE HAYNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

886 N COFCO CENTER CT UNIT 1118
PHOENIX AZ
85008-6446
US

IV. Provider business mailing address

14854 N 172ND LN
SURPRISE AZ
85388-7828
US

V. Phone/Fax

Practice location:
  • Phone: 317-869-3035
  • Fax: 218-663-2364
Mailing address:
  • Phone: 317-869-3035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: