Provider Demographics
NPI:1053964593
Name:EIGHT ANGELS HOME HEALTH LLC
Entity type:Organization
Organization Name:EIGHT ANGELS HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:NAVARRO
Authorized Official - Last Name:PUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-878-8918
Mailing Address - Street 1:1930 S ALMA SCHOOL RD STE B106
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3040
Mailing Address - Country:US
Mailing Address - Phone:480-590-0239
Mailing Address - Fax:480-590-0653
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE B106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3040
Practice Address - Country:US
Practice Address - Phone:480-590-0239
Practice Address - Fax:480-590-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007454OtherAHCCCS