Basic Information
Provider Information | |||||||||
NPI: | 1487090262 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SHHPHX LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SUNLIFE HOME HEALTH | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 627 N 6TH AVE | ||||||||
Address2: |   | ||||||||
City: | TUCSON | ||||||||
State: | AZ | ||||||||
PostalCode: | 857058330 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5208881311 | ||||||||
FaxNumber: | 8889086830 | ||||||||
Practice Location | |||||||||
Address1: | 1930 S ALMA SCHOOL RD | ||||||||
Address2: | SUITE C205 | ||||||||
City: | MESA | ||||||||
State: | AZ | ||||||||
PostalCode: | 852103064 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4804481588 | ||||||||
FaxNumber: | 8889086830 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/20/2013 | ||||||||
LastUpdateDate: | 05/20/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MURPHY | ||||||||
AuthorizedOfficialFirstName: | ROBERT | ||||||||
AuthorizedOfficialMiddleName: | W | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
AuthorizedOfficialTelephone: | 5208881311 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X |   | AZ | Y |   | Agencies | Home Health |   |
ID Information
ID | Type | State | Issuer | Description | 037282 | 01 | AZ | CMS CERTIFICATION NUMBER | OTHER |