Provider Demographics
NPI:1730467580
Name:SHARON RUSSELL
Entity Type:Organization
Organization Name:SHARON RUSSELL
Other - Org Name:ASHINEE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-713-2649
Mailing Address - Street 1:POST OFFICE BOX 87
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504
Mailing Address - Country:US
Mailing Address - Phone:505-713-2649
Mailing Address - Fax:180-096-7431
Practice Address - Street 1:ROUTE 12 OLD CRYSTAL ROAD ON LEFT
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:505-713-2649
Practice Address - Fax:180-096-7431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ433145Medicaid
AZ433145OtherAHCCCS PROVIDER