Provider Demographics
NPI:1629089362
Name:PREFERRED HOMECARE INFUSION LLC
Entity Type:Organization
Organization Name:PREFERRED HOMECARE INFUSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-446-9010
Mailing Address - Street 1:PO BOX 40700
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85274-0700
Mailing Address - Country:US
Mailing Address - Phone:480-446-9010
Mailing Address - Fax:480-993-2033
Practice Address - Street 1:11703 E SPRAGUE AVE STE C3
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206
Practice Address - Country:US
Practice Address - Phone:509-921-6560
Practice Address - Fax:509-921-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60202268251F00000X, 332BP3500X, 332BX2000X, 3336H0001X
ID1820MS3336M0002X
ORRP 001683 CS3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2086032Medicaid
WA2086032Medicaid
WA5068000007Medicare NSC
WA9050295Medicaid
WA7331606Medicaid