Provider Demographics
NPI:1972999100
Name:COPPER STATE HOME HEALTH, LLC
Entity Type:Organization
Organization Name:COPPER STATE HOME HEALTH, LLC
Other - Org Name:COPPER STATE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DON ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELLISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-200-9708
Mailing Address - Street 1:996 N BROAD ST STE 7
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-2300
Mailing Address - Country:US
Mailing Address - Phone:928-200-9708
Mailing Address - Fax:602-926-2423
Practice Address - Street 1:996 N BROAD ST STE 7
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2300
Practice Address - Country:US
Practice Address - Phone:928-200-9708
Practice Address - Fax:602-926-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health