Provider Demographics
NPI:1316108145
Name:INNOVATIVE HOME HEALTH CARE INC
Entity type:Organization
Organization Name:INNOVATIVE HOME HEALTH CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER-M.S.
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:SKURDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-243-4231
Mailing Address - Street 1:1402 E SOUTH MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-7925
Mailing Address - Country:US
Mailing Address - Phone:602-243-4231
Mailing Address - Fax:602-323-5988
Practice Address - Street 1:2601 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8221
Practice Address - Country:US
Practice Address - Phone:602-305-9500
Practice Address - Fax:602-305-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA3379251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZHHA3379OtherAZ DEPARTMENT OF HEALTH SERVICES
AZ818552Medicaid
AZMED2362Medicare PIN
AZ037224Medicare Oscar/Certification