Provider Demographics
NPI:1821031485
Name:BANNER HOME CARE-ARIZONA
Entity Type:Organization
Organization Name:BANNER HOME CARE-ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AMBULATORY
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:COTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-747-4000
Mailing Address - Street 1:2901 N CENTRAL AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:275 E GERMANN RD
Practice Address - Street 2:STE 110
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-2905
Practice Address - Country:US
Practice Address - Phone:480-657-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BANNER HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-13
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ013293Medicaid
AZ013293Medicaid