Provider Demographics
NPI:1447931134
Name:HUACHUCA HEALTHCARE, LLC
Entity type:Organization
Organization Name:HUACHUCA HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-369-7608
Mailing Address - Street 1:1048 E FRY BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1048 E FRY BLVD STE E
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2683
Practice Address - Country:US
Practice Address - Phone:520-458-9450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based