1750794103 NPI number — HONORA HEALTHCARE SERVICES, LLC.

Table of content: (NPI 1750794103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750794103 NPI number — HONORA HEALTHCARE SERVICES, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HONORA HEALTHCARE SERVICES, 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:
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:
1750794103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 E RIO SALADO PKWY
Provider Second Line Business Mailing Address:
SUITE 900
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85281-9124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-330-3472
Provider Business Mailing Address Fax Number:
888-818-4521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 E RIO SALADO PKWY
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85281-9124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-330-3472
Provider Business Practice Location Address Fax Number:
888-818-4521
Provider Enumeration Date:
06/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
OMOSOWON
Authorized Official First Name:
SAMSON
Authorized Official Middle Name:
FOLORUNSO
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
480-335-3099

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  RN156392 , 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: RN156392 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 658864 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com