Provider Demographics
NPI:1861558256
Name:HI PHOENIX, LLC
Entity type:Organization
Organization Name:HI PHOENIX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-588-7725
Mailing Address - Street 1:2412 W GREENWAY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-4241
Mailing Address - Country:US
Mailing Address - Phone:602-588-7725
Mailing Address - Fax:602-588-7735
Practice Address - Street 1:2412 W GREENWAY RD
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-4241
Practice Address - Country:US
Practice Address - Phone:602-588-7725
Practice Address - Fax:602-588-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ617605Medicaid