Provider Demographics
NPI:1871779249
Name:SAGUARO HOME HEALTH SERVICES INC.
Entity type:Organization
Organization Name:SAGUARO HOME HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIMACULANGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:702-248-6850
Mailing Address - Street 1:2770 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1554
Mailing Address - Country:US
Mailing Address - Phone:702-248-6850
Mailing Address - Fax:702-650-3540
Practice Address - Street 1:2770 S MARYLAND PKWY
Practice Address - Street 2:SUITE 215
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1554
Practice Address - Country:US
Practice Address - Phone:702-248-6850
Practice Address - Fax:702-650-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV606HHA-10251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2902018Medicaid
NV297082Medicare Oscar/Certification