Provider Demographics
NPI:1518246305
Name:INK HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:INK HEALTHCARE GROUP LLC
Other - Org Name:INK HOMECARE AND SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-218-5391
Mailing Address - Street 1:PO BOX 26362
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068-6362
Mailing Address - Country:US
Mailing Address - Phone:602-218-5391
Mailing Address - Fax:602-427-0088
Practice Address - Street 1:8020 N 12TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3802
Practice Address - Country:US
Practice Address - Phone:602-218-5391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INK HEALTHCARE GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-10
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL16865045251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care