MEDICARE: VCG ARIZONA 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HHA9614	OTHER	AZ	STATE OF ARIZONA LICENSE

General Provider Information

NPI Number	:	1992484729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VCG ARIZONA LLC

Provider Business Mailing Address
First Line	:	8150 N CENTRAL EXPY STE 1800
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-1883
Country	:	US
Telephone Number	:	903-787-7609
Fax Number	:	903-871-0005

Provider Business Practice Location Address
First Line	:	823 N SAN FRANCISCO ST STE 2-G1
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-3294
Country	:	US
Telephone Number	:	903-787-7609
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	CHRIS WALKER
Credential	:
Telephone Number	:	214-491-0041

Provider Enumeration Date	:	07/18/2023
Last Update Date	:	07/18/2023

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Directions to “VCG ARIZONA LLC ” Practice Location

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