Provider Demographics
NPI:1912316837
Name:CENTURY LAKE HOME HEALTH
Entity type:Organization
Organization Name:CENTURY LAKE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-203-8673
Mailing Address - Street 1:6960 W PEORIA AVE
Mailing Address - Street 2:#153
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6023
Mailing Address - Country:US
Mailing Address - Phone:623-203-8673
Mailing Address - Fax:623-486-8454
Practice Address - Street 1:6960 W PEORIA AVE
Practice Address - Street 2:#153
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6023
Practice Address - Country:US
Practice Address - Phone:623-203-8673
Practice Address - Fax:623-486-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health