Provider Demographics
NPI:1164395919
Name:COPPER STATE HOME CARE LLC
Entity type:Organization
Organization Name:COPPER STATE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENHALGH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:360-305-4766
Mailing Address - Street 1:16852 W NORTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-6891
Mailing Address - Country:US
Mailing Address - Phone:602-614-1958
Mailing Address - Fax:
Practice Address - Street 1:16852 W NORTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-6891
Practice Address - Country:US
Practice Address - Phone:602-614-1958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care