Provider Demographics
NPI:1366725889
Name:ARIZONA HOMECARE VENTURES, LLC
Entity type:Organization
Organization Name:ARIZONA HOMECARE VENTURES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-398-3018
Mailing Address - Street 1:1729 N TREKELL RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2215
Mailing Address - Country:US
Mailing Address - Phone:520-836-5046
Mailing Address - Fax:520-836-5047
Practice Address - Street 1:1729 N TREKELL RD
Practice Address - Street 2:SUITE 114
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2215
Practice Address - Country:US
Practice Address - Phone:520-836-5046
Practice Address - Fax:520-836-5047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA5182251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ037028Medicare Oscar/Certification