Provider Demographics
NPI:1447743125
Name:SELECT HOME CARE PHOENIX, LLC.
Entity Type:Organization
Organization Name:SELECT HOME CARE PHOENIX, LLC.
Other - Org Name:SELECT HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-490-0804
Mailing Address - Street 1:1 N MACDONALD STE 16
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-7340
Mailing Address - Country:US
Mailing Address - Phone:480-450-0804
Mailing Address - Fax:
Practice Address - Street 1:1 N MACDONALD STE 16
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7340
Practice Address - Country:US
Practice Address - Phone:480-450-0804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ338883Medicaid