Provider Demographics
NPI:1871753533
Name:THE HOME CARE SOLUTION LLC
Entity type:Organization
Organization Name:THE HOME CARE SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTCLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-871-5498
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:WINDOW ROCK
Mailing Address - State:AZ
Mailing Address - Zip Code:86515-0624
Mailing Address - Country:US
Mailing Address - Phone:928-871-5498
Mailing Address - Fax:928-871-2501
Practice Address - Street 1:18 KAIBETO DRIVE
Practice Address - Street 2:
Practice Address - City:WINDOW ROCK
Practice Address - State:AZ
Practice Address - Zip Code:86515
Practice Address - Country:US
Practice Address - Phone:928-871-5498
Practice Address - Fax:928-871-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ799489253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ799489Medicaid