Provider Demographics
NPI:1447277264
Name:STATESERV HOMECARE LLC
Entity type:Organization
Organization Name:STATESERV HOMECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-633-7250
Mailing Address - Street 1:1201 S. ALMA SCHOOL RD.
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210
Mailing Address - Country:US
Mailing Address - Phone:877-633-7250
Mailing Address - Fax:866-280-0415
Practice Address - Street 1:1201 S. ALMA SCHOOL RD
Practice Address - Street 2:SUITE 4000
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210
Practice Address - Country:US
Practice Address - Phone:480-797-8061
Practice Address - Fax:866-280-0415
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE STATESERV COMPANIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-16
Last Update Date:2024-02-22
Deactivation Date:2019-10-23
Deactivation Code:
Reactivation Date:2020-02-17
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5619060001Medicare NSC