Provider Demographics
NPI:1164311163
Name:COPPER VALLEY INTEGRATED HEALTH LLC
Entity type:Organization
Organization Name:COPPER VALLEY INTEGRATED HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUC-ARMAND
Authorized Official - Middle Name:
Authorized Official - Last Name:NINGUMIRIZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-409-4027
Mailing Address - Street 1:7317 W ST CATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7017
Mailing Address - Country:US
Mailing Address - Phone:207-409-4027
Mailing Address - Fax:
Practice Address - Street 1:7317 W ST CATHERINE AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7017
Practice Address - Country:US
Practice Address - Phone:207-409-4027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty