Provider Demographics
NPI:1558857318
Name:DESPAIN SENIOR CARE LLC
Entity Type:Organization
Organization Name:DESPAIN SENIOR CARE LLC
Other - Org Name:HOME INSTEAD SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-500-6550
Mailing Address - Street 1:17100 E SHEA BLVD STE 530
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-6661
Mailing Address - Country:US
Mailing Address - Phone:480-500-6550
Mailing Address - Fax:480-664-4295
Practice Address - Street 1:17100 E SHEA BLVD STE 530
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6661
Practice Address - Country:US
Practice Address - Phone:480-500-6550
Practice Address - Fax:480-664-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ346614Medicaid