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General NPI Number Information
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NPI Number | 1972999100
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Entity Type | Organization
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Legal Business Name | COPPER STATE HOME HEALTH, LLC
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 996 N BROAD ST STE 7
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City | GLOBE
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State | AZ
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Zip | 85501-2300
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Country | US
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Telephone | 928-200-9708
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Fax | 602-926-2423
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Provider Business Mailing Address
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Address Line | 996 N BROAD ST STE 7
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City | GLOBE
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State | AZ
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Zip | 85501-2300
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Country | US
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Telephone | 928-200-9708
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Fax | 602-926-2423
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Authorized Official
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Title or Position | DON ADMINISTRATOR
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Name | MELLISA MARIE TAYLOR
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Credential | RN
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Telephone | 928-200-9708
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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 | AZ
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