Provider Demographics
NPI:1508272188
Name:ONESOURCE SENIOR HEALTHCARE PLLC
Entity Type:Organization
Organization Name:ONESOURCE SENIOR HEALTHCARE PLLC
Other - Org Name:ONESOURCE MOBILE HEALTHCARE PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:888-495-4489
Mailing Address - Street 1:14050 N 83RD AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5650
Mailing Address - Country:US
Mailing Address - Phone:888-495-4489
Mailing Address - Fax:602-865-8090
Practice Address - Street 1:16427 N SCOTTSDALE RD STE 410
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-7102
Practice Address - Country:US
Practice Address - Phone:888-495-4889
Practice Address - Fax:602-325-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ944102Medicaid