Provider Demographics
NPI:1003383175
Name:AHEHEE' SHIDINE'E HOMECARE LLC
Entity Type:Organization
Organization Name:AHEHEE' SHIDINE'E HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TULLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-687-3110
Mailing Address - Street 1:7550 N 19TH AVENUE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-6997
Mailing Address - Country:US
Mailing Address - Phone:602-644-1707
Mailing Address - Fax:928-318-8777
Practice Address - Street 1:7550 N 19TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7981
Practice Address - Country:US
Practice Address - Phone:602-644-1707
Practice Address - Fax:928-318-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ429782Medicaid