Provider Demographics
NPI:1679635072
Name:DYNA CARE ARIZONA LLC
Entity Type:Organization
Organization Name:DYNA CARE ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABITURAB
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOXWALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-560-2925
Mailing Address - Street 1:1201 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 7550
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-2008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1553 W TODD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4805
Practice Address - Country:US
Practice Address - Phone:480-883-9295
Practice Address - Fax:480-883-9252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNA CARE ARIZONA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA3390251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ826878Medicaid
AZ037225Medicare Oscar/Certification