Organization
FOUNDATION HOME HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY SHACKELFORD JR. BSN (COO)
(928) 493-4410
Entity
Organization
Contact information
Practice address
1695 MESQUITE AVE STE 206, LAKE HAVASU CITY, AZ 86403-5688
(928) 493-4410
(928) 302-1907
Mailing address
1695 MESQUITE AVE STE 206, LAKE HAVASU CITY, AZ 86403-5688
(928) 493-4410
(928) 302-1907
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
AZ
Other
Enumeration date
12/06/2017
Last updated
06/06/2022
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