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General NPI Number Information
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NPI Number | 1063501948
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Entity Type | Organization
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Legal Business Name | SELECTIVE HEALTHCARE INC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 03/14/2011
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Provider Practice Location Address
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Address Line | 19841 N 68TH DR
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City | GLENDALE
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State | AZ
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Zip | 85308-5593
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Country | US
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Telephone | 623-533-8181
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Fax | 623-362-2242
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Provider Business Mailing Address
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Address Line | 19841 N 68TH DR
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City | GLENDALE
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State | AZ
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Zip | 85308-5593
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Country | US
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Telephone | 623-533-8181
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Fax | 623-362-2242
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Authorized Official
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Title or Position | PRESIDENT , CEO
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Name | MRS. MERI J. BACON
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Credential |
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Telephone | 623-533-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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