Provider Demographics
NPI:1881167914
Name:AZHOMEHEALTH LLC
Entity type:Organization
Organization Name:AZHOMEHEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-535-0610
Mailing Address - Street 1:2929 N 44TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7239
Mailing Address - Country:US
Mailing Address - Phone:602-820-6651
Mailing Address - Fax:602-293-3717
Practice Address - Street 1:919 12TH PL STE 5
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1433
Practice Address - Country:US
Practice Address - Phone:602-535-0610
Practice Address - Fax:602-293-3717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AZHOMEHEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-11
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ494905Medicaid