Provider Demographics
NPI:1104430024
Name:RUCAN HEALTH ANGELS LLC
Entity type:Organization
Organization Name:RUCAN HEALTH ANGELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAFOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-492-6292
Mailing Address - Street 1:270 E HUNT HIGHWAY
Mailing Address - Street 2:SUITE 16. #253
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-4964
Mailing Address - Country:US
Mailing Address - Phone:480-492-6292
Mailing Address - Fax:
Practice Address - Street 1:625 W SOUTHERN AVE STE E
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5018
Practice Address - Country:US
Practice Address - Phone:480-492-6292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUCAN HEALTH ANGELS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health