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General NPI Number Information
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NPI Number | 1205186202
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Entity Type | Organization
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Legal Business Name | PVAA HEALTHCARE SERVICES INC.
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 5315 EAST BROADWAY BLVD SUITE 208B
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City | TUCSON
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State | AZ
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Zip | 85711
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Country | US
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Telephone | 520-207-9315
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Fax |
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Provider Business Mailing Address
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Address Line | 7390 E SYCAMORE PARK BLVD
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City | TUCSON
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State | AZ
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Zip | 85756-6122
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Country | US
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Telephone | 520-207-9315
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. PAULINE A TAKU
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Credential | RN
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Telephone | 520-207-9315
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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 | HHA5246
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License Number State | AZ
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