Provider Demographics
NPI:1922444140
Name:AVENTAS HOME HEALTH, LLC
Entity Type:Organization
Organization Name:AVENTAS HOME HEALTH, LLC
Other - Org Name:AVENTAS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-207-4111
Mailing Address - Street 1:2193 N CAMINO PRINCIPAL
Mailing Address - Street 2:SUITE # 161
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-5336
Mailing Address - Country:US
Mailing Address - Phone:520-207-4111
Mailing Address - Fax:520-207-5577
Practice Address - Street 1:2193 N CAMINO PRINCIPAL
Practice Address - Street 2:SUITE # 161
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5336
Practice Address - Country:US
Practice Address - Phone:520-207-4111
Practice Address - Fax:520-207-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA5818251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ856385Medicaid