1467767012 NPI number — AHPC PHOENIX, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467767012 NPI number — AHPC PHOENIX, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AHPC PHOENIX, LLC
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:
AT HOME PERSONAL 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:
1467767012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 N 32ND ST STE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85018-3350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-497-4347
Provider Business Mailing Address Fax Number:
480-926-0221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2444 E SOUTHERN AVE STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85204-5418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-497-4347
Provider Business Practice Location Address Fax Number:
480-926-0221
Provider Enumeration Date:
08/06/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUSKIRK
Authorized Official First Name:
CHRISTY
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
801-746-5558

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  HHA4863 , 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)