Organization
AEGIS HOMECARE, INC
Active
Other names
Aegis Homecare
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN LARSEN (ADMINISTRATOR)
(435) 754-4962
Entity
Organization
Contact information
Practice address
7227 E BASELINE RD STE 127, MESA, AZ 85209-5006
(480) 219-4790
(480) 584-5871
Mailing address
7227 E BASELINE RD STE 127, MESA, AZ 85209-5006
(480) 219-4790
(480) 584-5871
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03D2038146
CLIA WAIVER
AZ
05
—
746297
—
AZ
01
—
HHA5406
ARIZONA STATE LICENSE
AZ
Enumeration date
02/15/2012
Last updated
12/20/2019
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