Provider Demographics
NPI:1346060456
Name:2ND HOME SKILLED CARE SERVICES ARIZONA LLC
Entity type:Organization
Organization Name:2ND HOME SKILLED CARE SERVICES ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HANEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-999-7763
Mailing Address - Street 1:3131 S VAUGHN WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3508
Mailing Address - Country:US
Mailing Address - Phone:303-999-7763
Mailing Address - Fax:
Practice Address - Street 1:2325 E CAMELBACK RD STE 476
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3422
Practice Address - Country:US
Practice Address - Phone:303-999-7763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health