1194781682 NPI number — PINAL COUNTY ARIZONA

Table of content: (NPI 1194781682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194781682 NPI number — PINAL COUNTY ARIZONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINAL COUNTY ARIZONA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HORIZON HOME CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194781682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2986
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85232-2986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-866-4500
Provider Business Mailing Address Fax Number:
520-866-4529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
971 N JASON LOPEZ CIRCLE
Provider Second Line Business Practice Location Address:
BLDG E
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85232-2986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-866-4500
Provider Business Practice Location Address Fax Number:
520-866-4529
Provider Enumeration Date:
04/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHRISTIANSEN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
FINANCE MANAGER
Authorized Official Telephone Number:
520-886-4500

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA0033 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)