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General NPI Number Information
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NPI Number | 1366114233
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Entity Type | Organization
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Legal Business Name | MGA HOME HEALTHCARE WASHINGTON LLC
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 19401 40TH AVE W STE 312
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City | LYNNWOOD
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State | WA
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Zip | 98036-5600
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Country | US
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Telephone | 425-321-5742
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Fax | 425-264-8115
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Provider Business Mailing Address
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Address Line | 7025 N SCOTTSDALE RD STE 200
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City | SCOTTSDALE
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State | AZ
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Zip | 85253-3675
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AREA VICE PRESIDENT
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Name | ANTHONY VENZOR
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Credential |
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Telephone | 425-321-5742
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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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