Provider Demographics
NPI:1235537879
Name:UNIVERSAL IN-HOME SUPPORTIVE SERIVICES
Entity Type:Organization
Organization Name:UNIVERSAL IN-HOME SUPPORTIVE SERIVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VIKTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-659-7561
Mailing Address - Street 1:3639 E LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-8310
Mailing Address - Country:US
Mailing Address - Phone:480-659-7561
Mailing Address - Fax:480-659-8164
Practice Address - Street 1:3639 E LOUISE DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-8310
Practice Address - Country:US
Practice Address - Phone:480-659-7561
Practice Address - Fax:480-659-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-14
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-599063-B253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care