=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427632249
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PASSION HOME HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2021
-----------------------------------------------------
Last Update Date | 06/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7702 E DOUBLETREE RANCH RD STE 300
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85258-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-296-5429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7702 E DOUBLETREE RANCH ROAD SUITE 300 OFFICE 335
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85258-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-296-5429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. NICHOLAS XAVIER CICCIARELLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-296-5429
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------