Provider Demographics
NPI:1245224096
Name:HOME HEALTH AGENCY - ARIZONA LLC
Entity Type:Organization
Organization Name:HOME HEALTH AGENCY - ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-382-8500
Mailing Address - Street 1:2999 N 44TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7247
Mailing Address - Country:US
Mailing Address - Phone:602-382-8500
Mailing Address - Fax:602-253-5656
Practice Address - Street 1:3033 N 44TH ST STE 330
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7229
Practice Address - Country:US
Practice Address - Phone:602-382-8500
Practice Address - Fax:602-253-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA3590251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
037234Medicare PIN
AZ037234Medicare Oscar/Certification