Provider Demographics
NPI:1578277489
Name:HOME AND HANDS TOTAL CARE LLC
Entity Type:Organization
Organization Name:HOME AND HANDS TOTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACKERY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-601-6023
Mailing Address - Street 1:530 S DOBSON RD APT 342
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-1848
Mailing Address - Country:US
Mailing Address - Phone:602-602-6023
Mailing Address - Fax:
Practice Address - Street 1:530 S DOBSON RD APT 342
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-1848
Practice Address - Country:US
Practice Address - Phone:480-826-4661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ121212000054Medicaid