Provider Demographics
NPI:1568526770
Name:HAGGAI HEALTHCARE CORP.
Entity Type:Organization
Organization Name:HAGGAI HEALTHCARE CORP.
Other - Org Name:HAGGAI HEALTHCARE CORP.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-943-5963
Mailing Address - Street 1:4531 N 16TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5344
Mailing Address - Country:US
Mailing Address - Phone:602-697-1666
Mailing Address - Fax:602-943-4516
Practice Address - Street 1:4531 N 16TH ST
Practice Address - Street 2:STE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5322
Practice Address - Country:US
Practice Address - Phone:602-943-5963
Practice Address - Fax:602-943-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA3650251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ074355Medicaid
AZ037239Medicare ID - Type Unspecified