MEDICARE: IBHA HOME CARE SOLUTIONS

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	BH-3341	AZ

General Provider Information

NPI Number	:	1538397567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IBHA HOME CARE SOLUTIONS

Provider Business Mailing Address
First Line	:	2016 E DANBURY RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-2298
Country	:	US
Telephone Number	:	602-795-8336
Fax Number	:	619-374-7150

Provider Business Practice Location Address
First Line	:	2016 E DANBURY RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-2298
Country	:	US
Telephone Number	:	602-795-8336
Fax Number	:	619-374-7150

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. TARAS COLLUM SR.
Credential	:
Telephone Number	:	702-235-5650

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

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