Provider Demographics
NPI:1427065093
Name:LITTLE RIVER RESPIRATORY CARE, INC
Entity type:Organization
Organization Name:LITTLE RIVER RESPIRATORY CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:480-325-8011
Mailing Address - Street 1:5540 E BROADWAY RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1440
Mailing Address - Country:US
Mailing Address - Phone:480-325-8011
Mailing Address - Fax:480-325-7796
Practice Address - Street 1:5540 E BROADWAY RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1440
Practice Address - Country:US
Practice Address - Phone:480-325-8011
Practice Address - Fax:480-325-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ105930332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ551269Medicaid
AZ00200886OtherSALES TAX LICENSE
AZ07-30169-MOtherBUS RETAIL LICENSE
AZ105930OtherBOARD OF PHARM O2 LICENSE
AZ105930OtherBOARD OF PHARM O2 LICENSE
AZ551269Medicaid