Provider Demographics
NPI:1508895715
Name:VALLEY HOME CARE, LLC
Entity Type:Organization
Organization Name:VALLEY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-842-0900
Mailing Address - Street 1:23460 N 19TH AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2166
Mailing Address - Country:US
Mailing Address - Phone:623-842-0900
Mailing Address - Fax:623-842-0123
Practice Address - Street 1:23460 N 19TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:623-842-0900
Practice Address - Fax:623-842-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA3923251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0445420OtherBLUE CROSS BLUE SHIELD
AZ200370OtherAHCCCS ID
AZHHA3923OtherSTATE LICENSE NUMBER
AZAZ0445420OtherBLUE CROSS BLUE SHIELD