Provider Demographics
NPI:1669826673
Name:ARIZONA SENIOR HOME CARE
Entity Type:Organization
Organization Name:ARIZONA SENIOR HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:MELLISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DON
Authorized Official - Phone:928-425-4663
Mailing Address - Street 1:2123 SUNSET PT STE A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:AZ
Mailing Address - Zip Code:85539-1347
Mailing Address - Country:US
Mailing Address - Phone:928-425-4663
Mailing Address - Fax:800-832-9131
Practice Address - Street 1:2123 SUNSET PT STE A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:AZ
Practice Address - Zip Code:85539-1347
Practice Address - Country:US
Practice Address - Phone:928-425-4663
Practice Address - Fax:800-832-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA5649251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1548529373OtherNPI