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General NPI Number Information
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NPI Number | 1750562302
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Entity Type | Organization
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Legal Business Name | WATERMARK HOME CARE OF ARIZONA, LLC
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Dates
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Enumeration Date | 11/23/2007
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 6240 E THOMAS RD SUITE 203
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-7017
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Country | US
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Telephone | 480-946-4145
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Fax | 480-946-1280
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Provider Business Mailing Address
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Address Line | 6240 E THOMAS RD SUITE 203
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-7017
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Country | US
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Telephone | 480-946-4145
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Fax | 480-946-1280
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROBERT J MILLER
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Credential |
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Telephone | 480-946-4145
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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 | 0882447
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License Number State | AZ
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