Provider Demographics
NPI:1649705765
Name:ESTRELLA HOME HEALTH CARE 2, INC.
Entity type:Organization
Organization Name:ESTRELLA HOME HEALTH CARE 2, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:WENDEL
Authorized Official - Middle Name:ADRAIN
Authorized Official - Last Name:AKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-792-7282
Mailing Address - Street 1:2990 E NORTHERN AVE STE C101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4839
Mailing Address - Country:US
Mailing Address - Phone:623-792-7282
Mailing Address - Fax:
Practice Address - Street 1:2990 E NORTHERN AVE STE C101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4839
Practice Address - Country:US
Practice Address - Phone:623-792-7282
Practice Address - Fax:623-792-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ430582Medicaid