PHC-Lake Havasu Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

HHA0063 Issued in AZ

Legal business name

PHC-LAKE HAVASU INC

Doing business as

Havasu Regional Medical Center Home Health

Practice address

1851 Mesquite Ave
Ste. 206
Lake Havasu City, AZ 86403-5677

Phone

(928) 680-1209

Fax

(928) 680-7914

NPI assigned

Aug 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Victor E. Giovanetti

Title

President

Phone

(615) 920-7000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Havasu Regional Medical Center Home Health Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Arizona in-Home Partner-I, LLC

  • Home Health Agency
  • Lake Havasu City, AZ
  • NPI 1487190658

  Sold to, 2017-01-01

  CMS change of ownership

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437609600000",
    "number": "1245343482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274536",
            "telephone_number": "615-920-7000",
            "fax_number": "615-920-8913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1851 MESQUITE AVE",
            "address_2": "STE. 206",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035677",
            "telephone_number": "928-680-1209",
            "fax_number": "928-680-7914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHC-LAKE HAVASU INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2015-07-23",
        "status": "A",
        "authorized_official_last_name": "GIOVANETTI",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AZ",
            "license": "HHA0063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "435992",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Havasu Regional Medical Center Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Peru
• Kishore Perumandla
• Brian Peters, MD
• Robert D Peterson, MD
• Petersons Home Care Inc
• Douglas George Pheling, MA
• Philip a St Raymond MD PLLC
• Cassidy Phoenix
• Physicians Integrated Health Group LLC
• Carol Pichardo

• Home Health Agency in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Home Health Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.