Provider Demographics
NPI:1043694326
Name:MOHAVE HEALTHCARE, INC.
Entity Type:Organization
Organization Name:MOHAVE HEALTHCARE, INC.
Other - Org Name:RIVER VALLEY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:1317 S JOSHUA AVE STE Q
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-5759
Mailing Address - Country:US
Mailing Address - Phone:928-689-0010
Mailing Address - Fax:928-669-0070
Practice Address - Street 1:1317 S JOSHUA AVE STE Q
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5759
Practice Address - Country:US
Practice Address - Phone:928-669-0010
Practice Address - Fax:928-669-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ037297Medicare Oscar/Certification