Provider Demographics
NPI:1750727715
Name:AVENTAS HOMECARE, LLC
Entity type:Organization
Organization Name:AVENTAS HOMECARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-300-5721
Mailing Address - Street 1:2193 N CAMINO PRINCIPAL
Mailing Address - Street 2:SUITE 145
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-5336
Mailing Address - Country:US
Mailing Address - Phone:520-300-5721
Mailing Address - Fax:520-300-6557
Practice Address - Street 1:2193 N CAMINO PRINCIPAL
Practice Address - Street 2:SUITE 145
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5336
Practice Address - Country:US
Practice Address - Phone:520-300-5721
Practice Address - Fax:520-300-6557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health