Provider Demographics
NPI:1275776015
Name:AVENTAS HOME HEALTH LLC
Entity Type:Organization
Organization Name:AVENTAS HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-300-5721
Mailing Address - Street 1:2201 N CAMINO PRINCIPAL
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-5320
Mailing Address - Country:US
Mailing Address - Phone:520-300-5721
Mailing Address - Fax:520-300-3662
Practice Address - Street 1:2201 N CAMINO PRINCIPAL
Practice Address - Street 2:SUITE 6
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5320
Practice Address - Country:US
Practice Address - Phone:520-300-5721
Practice Address - Fax:520-300-3662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health