Organization
SHARON RUSSELL
Active
Other names
Ashinee Home Health
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON LYNN RUSSELL (OWNER/HUMAN RESOURCES)
(505) 713-2649
Entity
Organization
Contact information
Practice address
ROUTE 12 OLD CRYSTAL ROAD ON LEFT, FORT DEFIANCE, AZ 86504
(505) 713-2649
(180) 096-7431
Mailing address
POST OFFICE BOX 87, FORT DEFIANCE, AZ 86504
(505) 713-2649
(180) 096-7431
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
433145
AHCCCS PROVIDER
AZ
05
—
433145
—
AZ
Enumeration date
07/28/2011
Last updated
08/15/2011
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