Provider Demographics
NPI:1780621060
Name:SUN VALLEY HOME CARE, LLC
Entity type:Organization
Organization Name:SUN VALLEY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONKS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:480-633-1555
Mailing Address - Street 1:7227 E BASELINE RD
Mailing Address - Street 2:#127
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-5005
Mailing Address - Country:US
Mailing Address - Phone:480-633-1555
Mailing Address - Fax:480-633-1556
Practice Address - Street 1:7227 E BASELINE RD
Practice Address - Street 2:#127
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-5005
Practice Address - Country:US
Practice Address - Phone:480-633-1555
Practice Address - Fax:480-633-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHH3865251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ037240Medicare ID - Type UnspecifiedPROVIDER NUMBER