Provider Demographics
NPI:1205186202
Name:PVAA HEALTHCARE SERVICES INC.
Entity Type:Organization
Organization Name:PVAA HEALTHCARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAKU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:520-207-9315
Mailing Address - Street 1:7390 E SYCAMORE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-6122
Mailing Address - Country:US
Mailing Address - Phone:520-207-9315
Mailing Address - Fax:
Practice Address - Street 1:5315 EAST BROADWAY BLVD SUITE 208B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-207-9315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA5246251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health