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General NPI Number Information
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NPI Number | 1356789648
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Entity Type | Organization
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Legal Business Name | SOREO SELECT LLC
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 07/01/2014
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Provider Practice Location Address
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Address Line | 1632 N COUNTRY CLUB RD
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City | TUCSON
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State | AZ
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Zip | 85716-3119
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Country | US
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Telephone | 520-321-4477
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Fax | 866-260-0343
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Provider Business Mailing Address
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Address Line | 1632 N COUNTRY CLUB RD
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City | TUCSON
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State | AZ
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Zip | 85716-3119
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Country | US
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Telephone | 520-321-4477
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Fax | 866-260-0343
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RAYMOND WALLACE
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Credential |
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Telephone | 520-321-4477
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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 | XXXX
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License Number State | AZ
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