Provider Demographics
NPI:1023286150
Name:PALO VERDE HOMECARE, LLC
Entity type:Organization
Organization Name:PALO VERDE HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGERONIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-529-8387
Mailing Address - Street 1:5055 E BROADWAY BLVD STE C214
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3626
Mailing Address - Country:US
Mailing Address - Phone:520-529-8387
Mailing Address - Fax:520-844-1111
Practice Address - Street 1:5055 E BROADWAY BLVD STE C214
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3626
Practice Address - Country:US
Practice Address - Phone:520-529-8387
Practice Address - Fax:520-844-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty