Healthcare Provider Details

I. General information

NPI: 1588956718
Provider Name (Legal Business Name): JIDLAND HOME HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 E SPEEDWAY BLVD STE 171
TUCSON AZ
85716-3993
US

IV. Provider business mailing address

3565 E SPEEDWAY BLVD STE 171
TUCSON AZ
85716-3993
US

V. Phone/Fax

Practice location:
  • Phone: 520-370-9564
  • Fax: 520-881-6777
Mailing address:
  • Phone: 520-370-9564
  • Fax: 520-881-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ISMAIL ABDULLE OSMAN
Title or Position: OWNER
Credential:
Phone: 520-370-9564