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General NPI Number Information
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NPI Number | 1619085289
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Entity Type | Organization
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Legal Business Name | HERITAGE HOME HEALTH CARE OF ARIZONIA
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2250 US HIGHWAY 60 SUITE J
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City | MIAMI
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State | AZ
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Zip | 85539-7715
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Country | US
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Telephone | 928-402-0060
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Fax | 928-402-0080
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Provider Business Mailing Address
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Address Line | 8212 LOUISIANA BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-2105
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Country | US
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Telephone | 505-796-3200
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Fax | 505-796-3234
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Authorized Official
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Title or Position | CFO
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Name | STEVE BOURNE
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Credential |
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Telephone | 505-796-3236
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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 | HHA4002
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License Number State | AZ
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