Provider Demographics
NPI:1144516444
Name:DORSEE INTERNATIONAL
Entity type:Organization
Organization Name:DORSEE INTERNATIONAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:L
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:480-306-5331
Mailing Address - Street 1:20701 N SCOTTSDALE RD
Mailing Address - Street 2:STE107-287
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6413
Mailing Address - Country:US
Mailing Address - Phone:480-306-5331
Mailing Address - Fax:
Practice Address - Street 1:20701 N SCOTTSDALE RD
Practice Address - Street 2:STE107-287
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6413
Practice Address - Country:US
Practice Address - Phone:480-306-5331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DORSEE INTERNATIONAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ616482Medicaid