Provider Demographics
NPI:1831207497
Name:HERITAGE HOME HEALTH CARE OF ARIZONIA
Entity type:Organization
Organization Name:HERITAGE HOME HEALTH CARE OF ARIZONIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-796-3236
Mailing Address - Street 1:8212 LOUISIANA BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2105
Mailing Address - Country:US
Mailing Address - Phone:505-796-3236
Mailing Address - Fax:505-796-3234
Practice Address - Street 1:317 E COTTONWOOD LN
Practice Address - Street 2:SUITE B
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-2517
Practice Address - Country:US
Practice Address - Phone:520-421-0097
Practice Address - Fax:520-421-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA4001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ132194Medicaid
AZ037222Medicare ID - Type UnspecifiedHOMEHEALTH