Provider Demographics
NPI:1821754573
Name:ARIZONA HOME CARE SPECIALISTS, INC.
Entity type:Organization
Organization Name:ARIZONA HOME CARE SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CHIEF EXECUTIVE OFFIC
Authorized Official - Prefix:
Authorized Official - First Name:WARDIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:KANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-493-9328
Mailing Address - Street 1:625 W. SOUTHERN AVE.
Mailing Address - Street 2:SUITE E
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210
Mailing Address - Country:US
Mailing Address - Phone:480-761-9900
Mailing Address - Fax:866-696-9233
Practice Address - Street 1:625 W. SOUTHERN AVE.
Practice Address - Street 2:SUITE E
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210
Practice Address - Country:US
Practice Address - Phone:480-761-9900
Practice Address - Fax:866-696-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ153810Medicaid