Provider Demographics
NPI:1851792808
Name:GRAND CANYON HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:GRAND CANYON HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMOV
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:602-441-2722
Mailing Address - Street 1:2320 W PEORIA AVE # C122B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4753
Mailing Address - Country:US
Mailing Address - Phone:602-441-2722
Mailing Address - Fax:602-441-5022
Practice Address - Street 1:2320 W PEORIA AVE STE C122B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4753
Practice Address - Country:US
Practice Address - Phone:602-441-2722
Practice Address - Fax:602-441-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ351219Medicaid