Provider Demographics
NPI:1710972856
Name:WESTERN ARIZONA REGIONAL HOME HEALTH AND HOSPICE, LLC
Entity Type:Organization
Organization Name:WESTERN ARIZONA REGIONAL HOME HEALTH AND HOSPICE, LLC
Other - Org Name:MOHAVE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:LYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-891-1044
Mailing Address - Street 1:9510 ORMSBY STATION RD
Mailing Address - Street 2:STE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4081
Mailing Address - Country:US
Mailing Address - Phone:502-891-1187
Mailing Address - Fax:502-891-8067
Practice Address - Street 1:2020 SILVER CREEK RD
Practice Address - Street 2:BLDG A - STE 114
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8476
Practice Address - Country:US
Practice Address - Phone:928-763-3184
Practice Address - Fax:928-763-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA3820251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZHHA3820OtherAZ LICENCE NO.
AZ037146Medicare Oscar/Certification