Provider Demographics
NPI:1568457612
Name:PAYSON HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:PAYSON HOME CARE SERVICES LLC
Other - Org Name:PAYSON REGIONAL HOME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OFFICE SUPPORT
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:708 E STATE HIGHWAY 260 STE A1
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4969
Mailing Address - Country:US
Mailing Address - Phone:928-472-5245
Mailing Address - Fax:928-472-5250
Practice Address - Street 1:708 E STATE HIGHWAY 260 STE A1
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4969
Practice Address - Country:US
Practice Address - Phone:928-472-5245
Practice Address - Fax:928-472-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA0139251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ394924Medicaid
AZ037114Medicare Oscar/Certification