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General NPI Number Information
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NPI Number | 1710972856
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Entity Type | Organization
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Legal Business Name | WESTERN ARIZONA REGIONAL HOME HEALTH AND HOSPICE, LLC
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 01/07/2017
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Provider Practice Location Address
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Address Line | 2020 SILVER CREEK RD BLDG A - STE 114
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8476
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Country | US
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Telephone | 928-763-3184
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Fax | 928-763-4122
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Provider Business Mailing Address
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Address Line | 9510 ORMSBY STATION RD STE 300
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City | LOUISVILLE
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State | KY
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Zip | 40223-4081
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Country | US
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Telephone | 502-891-1187
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Fax | 502-891-8067
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Authorized Official
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Title or Position | SR VICE PRESIDENT
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Name | PATRICK TODD LYLES
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Credential |
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Telephone | 502-891-1044
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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 | HHA3820
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License Number State | AZ
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