Provider Demographics
NPI:1497277545
Name:SACRED HEART HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:SACRED HEART HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-795-0739
Mailing Address - Street 1:1300 N 78TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-2406
Mailing Address - Country:US
Mailing Address - Phone:913-244-2753
Mailing Address - Fax:
Practice Address - Street 1:2737 E GREENWAY RD STE 6
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4391
Practice Address - Country:US
Practice Address - Phone:602-795-0739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA5140251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03-7438Medicaid