Provider Demographics
NPI:1841818887
Name:ARIZONA HEARTLANDS HOME CARE, LLC
Entity type:Organization
Organization Name:ARIZONA HEARTLANDS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JIDELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYONGALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-330-5824
Mailing Address - Street 1:14626 W. WETHERSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379
Mailing Address - Country:US
Mailing Address - Phone:623-330-5824
Mailing Address - Fax:888-778-1251
Practice Address - Street 1:14626 W. WETHERSFIELD RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379
Practice Address - Country:US
Practice Address - Phone:623-330-5824
Practice Address - Fax:888-778-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty