MEDICARE: HOMECARE HOME HEMODIALYSIS, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	2472R0900X	Renal Dialysis Technician
3	251F00000X	Home Infusion Agency

General Provider Information

NPI Number	:	1487461539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMECARE HOME HEMODIALYSIS, PLLC

Provider Business Mailing Address
First Line	:	17677 W COUNTRY CLUB TER
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85387-4026
Country	:	US
Telephone Number	:	480-578-4536
Fax Number	:

Provider Business Practice Location Address
First Line	:	6121 N 52ND PL
Second Line	:
City	:	PARADISE VALLEY
State	:	AZ
Zip	:	85253-5105
Country	:	US
Telephone Number	:	480-578-3426
Fax Number	:

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	MS. LEA HOLMAN
Credential	:	CCHT
Telephone Number	:	480-578-4536

Provider Enumeration Date	:	12/12/2024
Last Update Date	:	01/16/2025

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