Provider Demographics
NPI:1912640673
Name:TYLERS PLACE AZ INC
Entity type:Organization
Organization Name:TYLERS PLACE AZ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANASAGASTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-309-1600
Mailing Address - Street 1:2450 S GILBERT RD STE 211
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1595
Mailing Address - Country:US
Mailing Address - Phone:480-794-9984
Mailing Address - Fax:
Practice Address - Street 1:1823 E QUEEN CREEK RD STE 4
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2018
Practice Address - Country:US
Practice Address - Phone:480-794-9984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1588904379OtherTHERAPIST
AZ1477219210OtherTHERAPIST