Provider Demographics
NPI:1285679555
Name:MAXICARE HOME HEALTH, INC.
Entity Type:Organization
Organization Name:MAXICARE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DON
Authorized Official - Prefix:MS
Authorized Official - First Name:MUINAT
Authorized Official - Middle Name:A
Authorized Official - Last Name:UDOINWANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-246-1115
Mailing Address - Street 1:PO BOX 46363
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85063-6363
Mailing Address - Country:US
Mailing Address - Phone:602-246-1115
Mailing Address - Fax:602-246-1114
Practice Address - Street 1:2432 W PEORIA AVE STE 1120
Practice Address - Street 2:BLDG 5
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4733
Practice Address - Country:US
Practice Address - Phone:602-246-1115
Practice Address - Fax:602-246-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA3362251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZHHA3362OtherSTATE OF AZ LICENSE
AZ955693Medicaid
03-7229Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID#