1487824561 NPI number — DMR HOMECARE LLC

Table of content: (NPI 1487824561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487824561 NPI number — DMR HOMECARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DMR HOMECARE 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:
Provider Other Organization Name Type Code:
6
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:
1487824561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 E TANGER DR STE 109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASA GRANDE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85122-9630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-494-9990
Provider Business Mailing Address Fax Number:
520-494-9122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 E TANGER DR
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
CASA GRANDE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85122-9608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-494-9990
Provider Business Practice Location Address Fax Number:
520-494-9122
Provider Enumeration Date:
03/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
520-494-9990

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  C000764 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 20262380 , 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)

  • Identifier: 305033 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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