1427720218 NPI number — PAINTED HILLS HOMECARE

Table of content: DR. CHRISTINE ANNE COOPER M.D. (NPI 1841510179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427720218 NPI number — PAINTED HILLS HOMECARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAINTED HILLS HOMECARE
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:
Provider Other Organization Name Type Code:
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:
1427720218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 635
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAGE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86040-0635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-485-1331
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 HAUL RD UNIT B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAGE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86040-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-485-1331
Provider Business Practice Location Address Fax Number:
928-484-2000
Provider Enumeration Date:
09/30/2021

Additional Information

Authorized Official

Authorized Official Last Name:
PIERSON
Authorized Official First Name:
LORRIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
981-485-1331

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 232248 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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