Provider Demographics
NPI:1104021302
Name:SHI HEART HOME HEALTH
Entity Type:Organization
Organization Name:SHI HEART HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-729-5319
Mailing Address - Street 1:PO BOX 2180
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-2180
Mailing Address - Country:US
Mailing Address - Phone:928-729-5319
Mailing Address - Fax:928-729-5526
Practice Address - Street 1:NORTH ROUTE 7, MILEPOST 1.5
Practice Address - Street 2:OLD CRYSTAL ROAD
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-5319
Practice Address - Fax:928-729-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ769705Medicaid