Healthcare Provider Details

I. General information

NPI: 1346745072
Provider Name (Legal Business Name): WATERSHED FINANCIAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7702 E DOUBLETREE RANCH RD STE 300
SCOTTSDALE AZ
85258-2132
US

IV. Provider business mailing address

7702 E DOUBLETREE RANCH RD STE 300
SCOTTSDALE AZ
85258-2132
US

V. Phone/Fax

Practice location:
  • Phone: 602-672-4818
  • Fax: 480-522-1444
Mailing address:
  • Phone: 602-672-4818
  • Fax: 480-522-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number320295
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number320295
License Number StateAZ

VIII. Authorized Official

Name: MR. NAJIB HODGE
Title or Position: PRESIDENT, CEO
Credential:
Phone: 602-672-4818