MEDICARE: NURSEIO HOME, LLC

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
2	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1427715168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSEIO HOME, LLC

Provider Business Mailing Address
First Line	:	39506 N DAISY MOUNTAIN DR STE 12245
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-1663
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	39506 N DAISY MOUNTAIN DR STE 12245
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-1663
Country	:	US
Telephone Number	:	480-296-3264
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	CALLIE OTT
Credential	:
Telephone Number	:	480-296-3264

Provider Enumeration Date	:	11/17/2021
Last Update Date	:	11/17/2021

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