Provider Demographics
NPI:1780084301
Name:HYDE PARK HOME HEALTHCARE
Entity type:Organization
Organization Name:HYDE PARK HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-330-2838
Mailing Address - Street 1:14850 N SCOTTSDALE RD
Mailing Address - Street 2:#450-B
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2798
Mailing Address - Country:US
Mailing Address - Phone:480-250-0304
Mailing Address - Fax:480-237-8770
Practice Address - Street 1:14850 N SCOTTSDALE RD
Practice Address - Street 2:#450-B
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2798
Practice Address - Country:US
Practice Address - Phone:480-250-0304
Practice Address - Fax:480-237-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA5794251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health