Provider Demographics
NPI:1740640325
Name:UNITED HEALTHY PERMANENTE, INC.
Entity type:Organization
Organization Name:UNITED HEALTHY PERMANENTE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VARDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURADYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-400-0005
Mailing Address - Street 1:13760 N 93RD AVE
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4201
Mailing Address - Country:US
Mailing Address - Phone:844-400-0005
Mailing Address - Fax:844-215-1241
Practice Address - Street 1:13760 N 93RD AVE
Practice Address - Street 2:SUITE 105A
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4201
Practice Address - Country:US
Practice Address - Phone:844-400-0005
Practice Address - Fax:844-215-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA6898251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZHHA6898OtherDEPARTMENT OF HEALTH