Organization
PHC-LAKE HAVASU INC
Active
Other names
Havasu Regional Medical Center Home Health
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR E. GIOVANETTI (PRESIDENT)
(615) 920-7000
Entity
Organization
Contact information
Practice address
1851 MESQUITE AVE, STE. 206, LAKE HAVASU CITY, AZ 86403-5677
(928) 680-1209
(928) 680-7914
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-4536
(615) 920-7000
(615) 920-8913
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HHA0063
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
435992
—
AZ
Enumeration date
08/15/2006
Last updated
07/23/2015
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