Provider Demographics
NPI:1356708655
Name:HOME HEALTH SERVICES, PLLC
Entity type:Organization
Organization Name:HOME HEALTH SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:623-363-8691
Mailing Address - Street 1:3628 W AIDAN LN
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3773
Mailing Address - Country:US
Mailing Address - Phone:623-363-8691
Mailing Address - Fax:
Practice Address - Street 1:19375 E. OASIS
Practice Address - Street 2:
Practice Address - City:BLACK CANYON CITY
Practice Address - State:AZ
Practice Address - Zip Code:85324
Practice Address - Country:US
Practice Address - Phone:623-363-8691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3297261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy