Healthcare Provider Details

I. General information

NPI: 1023051927
Provider Name (Legal Business Name): BANNER HOME CARE-ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13049 N 103RD AVE STE 232
SUN CITY AZ
85351-3054
US

IV. Provider business mailing address

2901 N CENTRAL AVE STE 160
PHOENIX AZ
85012-2702
US

V. Phone/Fax

Practice location:
  • Phone: 480-657-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA0015
License Number StateAZ

VIII. Authorized Official

Name: RUSSELL FUNK
Title or Position: CEO
Credential:
Phone: 602-747-4000