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General NPI Number Information
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NPI Number | 1417776501
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Entity Type | Organization
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Legal Business Name | HUACHUCA HEALTHCARE, LLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 1048 E FRY BLVD STE F
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2683
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Country | US
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Telephone | 520-458-9450
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Fax |
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Provider Business Mailing Address
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Address Line | 1048 E FRY BLVD STE F
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2683
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Country | US
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Telephone | 520-458-9450
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | AMBER L TUELLER
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Credential |
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Telephone | 208-207-2726
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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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