Provider Demographics
NPI:1336937515
Name:PLATINUM HOME CARE ARIZONA LLC
Entity type:Organization
Organization Name:PLATINUM HOME CARE ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-978-5520
Mailing Address - Street 1:1430 THRUSH AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2096
Mailing Address - Country:US
Mailing Address - Phone:510-978-5520
Mailing Address - Fax:
Practice Address - Street 1:4539 N 22ND ST STE R
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4639
Practice Address - Country:US
Practice Address - Phone:510-306-2336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-28
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty