Provider Demographics
NPI:1427391531
Name:PATAGONIA ASSISTED CARE LLC
Entity Type:Organization
Organization Name:PATAGONIA ASSISTED CARE LLC
Other - Org Name:PATAGONIA ASSISTED CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-710-7946
Mailing Address - Street 1:361 WAGONER WAY P.O. BOX 43
Mailing Address - Street 2:
Mailing Address - City:PATAGONIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85624-0043
Mailing Address - Country:US
Mailing Address - Phone:520-604-8179
Mailing Address - Fax:520-842-2624
Practice Address - Street 1:361 WAGONER WAY
Practice Address - Street 2:
Practice Address - City:PATAGONIA
Practice Address - State:AZ
Practice Address - Zip Code:85624-0043
Practice Address - Country:US
Practice Address - Phone:520-604-8179
Practice Address - Fax:520-842-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health