Provider Demographics
NPI:1750794103
Name:HONORA HEALTHCARE SERVICES, LLC.
Entity type:Organization
Organization Name:HONORA HEALTHCARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:FOLORUNSO
Authorized Official - Last Name:OMOSOWON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-335-3099
Mailing Address - Street 1:60 E RIO SALADO PKWY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-9124
Mailing Address - Country:US
Mailing Address - Phone:602-330-3472
Mailing Address - Fax:888-818-4521
Practice Address - Street 1:60 E RIO SALADO PKWY
Practice Address - Street 2:SUITE 900
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-9124
Practice Address - Country:US
Practice Address - Phone:602-330-3472
Practice Address - Fax:888-818-4521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN156392251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN156392Medicaid
AZ658864Medicaid