MEDICARE: HACIENDA HOME HEALTH CARE INC

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		AZ

General Provider Information

NPI Number	:	1386160695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HACIENDA HOME HEALTH CARE INC

Provider Business Mailing Address
First Line	:	PO BOX 12767
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85732-2767
Country	:	US
Telephone Number	:	520-615-8181
Fax Number	:	520-308-3854

Provider Business Practice Location Address
First Line	:	5541 E GRANT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2209
Country	:	US
Telephone Number	:	520-269-6091
Fax Number	:	520-308-3854

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	VIVIAN RUTH UHLIG
Credential	:	CPA
Telephone Number	:	520-269-6091

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	06/16/2018

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