Provider Demographics
NPI:1790893352
Name:HERITAGE HOME HEALTH CARE OF ARIZONA, INC.
Entity Type:Organization
Organization Name:HERITAGE HOME HEALTH CARE OF ARIZONA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-796-3236
Mailing Address - Street 1:8212 LOUISIANA BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2105
Mailing Address - Country:US
Mailing Address - Phone:505-796-3236
Mailing Address - Fax:505-796-3234
Practice Address - Street 1:7493 N ORACLE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6343
Practice Address - Country:US
Practice Address - Phone:520-293-7270
Practice Address - Fax:520-293-7276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA-4000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ136995Medicaid
AZ037223Medicare ID - Type UnspecifiedHOMEHEALTH