Provider Demographics
NPI:1932340429
Name:MOTHER TERESA HOME HEALTH, LLC
Entity Type:Organization
Organization Name:MOTHER TERESA HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILOMINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-358-8179
Mailing Address - Street 1:10640 N 28TH DRIVE
Mailing Address - Street 2:SUITE C-205-17
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-2963
Mailing Address - Country:US
Mailing Address - Phone:602-358-8179
Mailing Address - Fax:602-997-6048
Practice Address - Street 1:10640 N 28TH DR
Practice Address - Street 2:SUITE C-205-17
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4527
Practice Address - Country:US
Practice Address - Phone:602-358-8179
Practice Address - Fax:602-997-6048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA4579251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health