Organization
ARIZONA HANDICAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROGER BRADLEY EADS (MEMBER)
(928) 533-4638
Entity
Organization
Contact information
Practice address
2069 YAVAPAI ST, CHINO VALLEY, AZ 86323-5292
(928) 533-4638
(928) 636-8134
Mailing address
2069 YAVAPAI ST, CHINO VALLEY, AZ 86323-5292
(928) 533-4638
(928) 636-8134
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
33181
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
412854
AHCCCS
AZ
Enumeration date
10/15/2009
Last updated
10/15/2009
Update your record
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