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General NPI Number Information
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NPI Number | 1669826673
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Entity Type | Organization
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Legal Business Name | ARIZONA SENIOR HOME CARE
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 04/15/2016
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Provider Practice Location Address
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Address Line | 2123 SUNSET PT STE A
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City | MIAMI
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State | AZ
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Zip | 85539-1347
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Country | US
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Telephone | 928-425-4663
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Fax | 800-832-9131
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Provider Business Mailing Address
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Address Line | 2123 SUNSET PT STE A
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City | MIAMI
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State | AZ
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Zip | 85539-1347
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Country | US
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Telephone | 928-425-4663
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Fax | 800-832-9131
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | MELLISA MARIE TAYLOR
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Credential | D.O.N
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Telephone | 928-425-4663
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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 | HHA5649
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License Number State | AZ
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