Provider Demographics
NPI:1669252193
Name:ARIZONA SUPERIOR HOME CARE LLC
Entity type:Organization
Organization Name:ARIZONA SUPERIOR HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:TEUILA
Authorized Official - Last Name:TEUMOHENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-772-8578
Mailing Address - Street 1:4965 E 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:APACHE JCT
Mailing Address - State:AZ
Mailing Address - Zip Code:85119-4772
Mailing Address - Country:US
Mailing Address - Phone:480-772-8578
Mailing Address - Fax:
Practice Address - Street 1:4965 E 22ND AVE
Practice Address - Street 2:
Practice Address - City:APACHE JCT
Practice Address - State:AZ
Practice Address - Zip Code:85119-4772
Practice Address - Country:US
Practice Address - Phone:480-772-8578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care