Provider Demographics
NPI:1821611583
Name:SOUTHERN ARIZONA HOME CARE
Entity Type:Organization
Organization Name:SOUTHERN ARIZONA HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLAEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-261-8716
Mailing Address - Street 1:PO BOX 4991
Mailing Address - Street 2:
Mailing Address - City:TUBAC
Mailing Address - State:AZ
Mailing Address - Zip Code:85646-4991
Mailing Address - Country:US
Mailing Address - Phone:520-261-8716
Mailing Address - Fax:520-844-6913
Practice Address - Street 1:2243 E FRONTAGE ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:TUBAC
Practice Address - State:AZ
Practice Address - Zip Code:85646-8564
Practice Address - Country:US
Practice Address - Phone:520-261-8716
Practice Address - Fax:520-844-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care