MEDICARE: DESERT SUN HOME HEALTH, 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	HHA5101	AZ

General Provider Information

NPI Number	:	1861771586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT SUN HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	4150 N 108TH AVE
Second Line	:	STE 138
City	:	PHOENIX
State	:	AZ
Zip	:	85037-5467
Country	:	US
Telephone Number	:	623-271-9755
Fax Number	:	623-271-9756

Provider Business Practice Location Address
First Line	:	4150 N 108TH AVE
Second Line	:	STE 138
City	:	PHOENIX
State	:	AZ
Zip	:	85037-5467
Country	:	US
Telephone Number	:	623-271-9755
Fax Number	:	623-271-9756

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. FELIZA P DISHON
Credential	:	BSN, RN
Telephone Number	:	623-271-9755

Provider Enumeration Date	:	08/11/2011
Last Update Date	:	08/11/2011

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