Provider Demographics
NPI:1457702219
Name:PA HEALTHCARE
Entity Type:Organization
Organization Name:PA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-931-0409
Mailing Address - Street 1:10750 W MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10750 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5960
Practice Address - Country:US
Practice Address - Phone:800-931-0409
Practice Address - Fax:888-502-2754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PA HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies