Provider Demographics
NPI:1912391640
Name:HOME ASSIST HEALTH
Entity Type:Organization
Organization Name:HOME ASSIST HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-795-7620
Mailing Address - Street 1:3737 N 7TH ST
Mailing Address - Street 2:203
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5017
Mailing Address - Country:US
Mailing Address - Phone:602-795-7620
Mailing Address - Fax:602-795-7621
Practice Address - Street 1:3737 N 7TH ST
Practice Address - Street 2:203
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5017
Practice Address - Country:US
Practice Address - Phone:602-795-7620
Practice Address - Fax:602-795-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care