Provider Demographics
NPI:1982088738
Name:METRO VALLEY HOME CARE LLC.
Entity type:Organization
Organization Name:METRO VALLEY HOME CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-251-6307
Mailing Address - Street 1:18181 W BRIDGER ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-1613
Mailing Address - Country:US
Mailing Address - Phone:623-251-6307
Mailing Address - Fax:623-251-6301
Practice Address - Street 1:18181 W BRIDGER ST
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-1613
Practice Address - Country:US
Practice Address - Phone:623-251-6307
Practice Address - Fax:623-251-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-11
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ009426Medicaid