Provider Demographics
NPI:1568547305
Name:MEDONE HEALTHCARE LLC
Entity Type:Organization
Organization Name:MEDONE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:L
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-835-9100
Mailing Address - Street 1:444 W 21ST ST STE 103
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2058
Mailing Address - Country:US
Mailing Address - Phone:480-835-9100
Mailing Address - Fax:480-835-9104
Practice Address - Street 1:444 W 21ST ST STE 103
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2058
Practice Address - Country:US
Practice Address - Phone:480-835-9100
Practice Address - Fax:480-835-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20031057251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health