Provider Demographics
NPI:1568433969
Name:ARIZONA HOME CARE LLC
Entity Type:Organization
Organization Name:ARIZONA HOME CARE LLC
Other - Org Name:ARIZONA HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-246-3968
Mailing Address - Street 1:1626 S EDWARD DRIVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281
Mailing Address - Country:US
Mailing Address - Phone:602-252-5000
Mailing Address - Fax:602-323-5070
Practice Address - Street 1:1626 S EDWARD DRIVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281
Practice Address - Country:US
Practice Address - Phone:602-252-5000
Practice Address - Fax:602-323-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA0268251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ382747-01Medicaid
AZ037199Medicare PIN