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General NPI Number Information
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NPI Number | 1861355067
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Entity Type | Organization
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Legal Business Name | FIRST SOURCE HEALTH LLC
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 9375 E SHEA BLVD STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6986
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Country | US
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Telephone | 480-450-0847
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Fax |
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Provider Business Mailing Address
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Address Line | 9375 E SHEA BLVD STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6986
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Country | US
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Telephone | 480-450-0847
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SUSAN ANDAZOLA
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Credential | NONE
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Telephone | 480-450-0847
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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 |
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License Number State |
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