Provider Demographics
NPI:1962101568
Name:SCOTTSDALE HOME IV AND SPECIALTY IV INVESTMENT, LLC
Entity type:Organization
Organization Name:SCOTTSDALE HOME IV AND SPECIALTY IV INVESTMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAWETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-534-1355
Mailing Address - Street 1:10752 N 89TH PL STE C-126
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6730
Mailing Address - Country:US
Mailing Address - Phone:480-534-1355
Mailing Address - Fax:480-281-5188
Practice Address - Street 1:10752 N 89TH PL STE C-126
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6730
Practice Address - Country:US
Practice Address - Phone:480-534-1355
Practice Address - Fax:480-281-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy