Provider Demographics
NPI:1083918866
Name:SOUTHWEST INDEPENDENCE, L.L.C.
Entity Type:Organization
Organization Name:SOUTHWEST INDEPENDENCE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-344-0399
Mailing Address - Street 1:22239 N 17TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-5615
Mailing Address - Country:US
Mailing Address - Phone:623-334-0399
Mailing Address - Fax:623-218-9095
Practice Address - Street 1:22239 N 17TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-5615
Practice Address - Country:US
Practice Address - Phone:623-344-0399
Practice Address - Fax:623-218-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care