Provider Demographics
NPI:1376277293
Name:PREMIER FAMILY CARE OF ARIZONA
Entity Type:Organization
Organization Name:PREMIER FAMILY CARE OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:LNA
Authorized Official - Phone:623-400-9200
Mailing Address - Street 1:18001 N 79TH AVE STE A8
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8389
Mailing Address - Country:US
Mailing Address - Phone:623-400-9200
Mailing Address - Fax:
Practice Address - Street 1:18001 N 79TH AVE STE A8
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8389
Practice Address - Country:US
Practice Address - Phone:623-400-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health