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General NPI Number Information
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NPI Number | 1932340429
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Entity Type | Organization
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Legal Business Name | MOTHER TERESA HOME HEALTH, LLC
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Dates
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Enumeration Date | 03/13/2009
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Last Update Date | 03/13/2009
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Provider Practice Location Address
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Address Line | 10640 N 28TH DR SUITE C-205-17
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City | PHOENIX
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State | AZ
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Zip | 85029-4527
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Country | US
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Telephone | 602-358-8179
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Fax | 602-997-6048
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Provider Business Mailing Address
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Address Line | 10640 N 28TH DRIVE SUITE C-205-17
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City | PHOENIX
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State | AZ
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Zip | 85029-2963
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Country | US
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Telephone | 602-358-8179
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Fax | 602-997-6048
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ILOMINDA OSBORNE
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Credential | RN
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Telephone | 602-358-8179
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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 | HHA4579
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License Number State | AZ
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