Provider Demographics
NPI:1063682920
Name:HUALAPAI HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:HUALAPAI HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MRACEK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-753-9015
Mailing Address - Street 1:2535 HUALAPAI MOUNTAIN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5493
Mailing Address - Country:US
Mailing Address - Phone:928-753-7828
Mailing Address - Fax:928-753-8946
Practice Address - Street 1:2535 HUALAPAI MOUNTAIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-5493
Practice Address - Country:US
Practice Address - Phone:928-753-9015
Practice Address - Fax:928-753-8946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA4555251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ037264Medicare Oscar/Certification