MEDICARE: BANNER HOME CARE-ARIZONA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1013452721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANNER HOME CARE-ARIZONA

Provider Business Mailing Address
First Line	:	2901 N CENTRAL AVE STE 160
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 E RIVER RD STE 102
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5822
Country	:	US
Telephone Number	:	520-694-9180
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RUSSELL FUNK
Credential	:
Telephone Number	:	602-747-4000

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	11/14/2025

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Directions to “BANNER HOME CARE-ARIZONA ” Practice Location

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