Provider Demographics
NPI:1306131917
Name:HOOVER, ANITA L
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:L
Last Name:HOOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 W PURPLE LEAF CT
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-7407
Mailing Address - Country:US
Mailing Address - Phone:520-575-4609
Mailing Address - Fax:520-296-8244
Practice Address - Street 1:1148 W PURPLE LEAF CT
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-7407
Practice Address - Country:US
Practice Address - Phone:520-575-4609
Practice Address - Fax:520-296-8244
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10680385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ10680OtherOLCR FOSTER CARE LICENSE