Provider Demographics
NPI:1538124938
Name:LIFE CARE AT HOME OF ARIZONA INC
Entity Type:Organization
Organization Name:LIFE CARE AT HOME OF ARIZONA INC
Other - Org Name:AFFINITY HOSPICE OF LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-473-5280
Mailing Address - Street 1:3001 KEITH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3713
Mailing Address - Country:US
Mailing Address - Phone:423-473-5280
Mailing Address - Fax:423-339-8356
Practice Address - Street 1:1661 E CAMELBACK RD
Practice Address - Street 2:SUITE 350
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3911
Practice Address - Country:US
Practice Address - Phone:602-253-2273
Practice Address - Fax:602-253-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC3847251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ138621Medicaid
AZ031566Medicare Oscar/Certification