NPIMap

Organization Active NPI

Arizona Home Care LLC

  • Home Health Agency
  • Tempe, AZ
National Provider Identifier
1568433969
Registry record updated Oct 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
HHA0268 Issued in AZ
Legal business name
ARIZONA HOME CARE LLC
Doing business as
Arizona Home Care LLC
Practice address
1626 S Edward Drive
Tempe, AZ 85281
Phone
(602) 252-5000
Fax
(602) 323-5070
NPI assigned
Feb 1, 2006
Last updated
Oct 21, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2015

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

Authorized official

Name
Mr. Jason Allen Smidt
Title
Coo
Phone
(480) 246-3968

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X HHA0268 AZ Primary

Addresses

Primary practice location

1626 S Edward Drive
Tempe, AZ 85281

Mailing address

1626 S Edward Drive
Tempe, AZ 85281
Phone (602) 252-5000

Other identifiers 1

IdentifierTypeStateIssuer
382747-01MedicaidAZ

Other names 1

  • Arizona Home Care LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060802000337 AZ Part A Provider - Home Health Agency 6406869700 Practice locations: Tempe, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568433969. Details of each certification follow.

Home health agency certification: CCN 037199

Legal name
ARIZONA HOME CARE LLC
Doing business as
ARIZONA HOME CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 28, 1996
Last certification
Apr 21, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
May 10, 1996 in AZ
Enrollment address
1626 S Edward Dr
Tempe, AZ 85281-6200
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Arizona Home CareCCN 037199 · All quality measures
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Oct 28, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Arizona Home Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ridge a Smidt Individual 5% Or Greater Direct Ownership Interest May 10, 1996 93%
Corporate DirectorCeo May 10, 1996 93%
P and T Committee LLC Organization, Tempe, AZ For-profit 5% Or Greater Indirect Ownership Interest May 10, 1996 100%
Operational/Managerial Control Apr 10, 2006 100%
Jason a Smidt Individual 5% Or Greater Direct Ownership Interest May 10, 1996 7%
Corporate DirectorCoo May 10, 1996 7%
W-2 Managing EmployeeCeo May 10, 1996 7%

Practitioners & affiliated clinicians

Affiliated clinicians 69

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 69

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445385600000",
    "number": "1568433969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 S EDWARD DRIVE",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "85281",
            "telephone_number": "602-252-5000",
            "fax_number": "602-323-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1626 S EDWARD DRIVE",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "85281",
            "telephone_number": "602-252-5000",
            "fax_number": "602-323-5070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2015-10-21",
        "status": "A",
        "authorized_official_last_name": "SMIDT",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "480-246-3968",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AZ",
            "license": "HHA0268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "382747-01",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arizona Home Care LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tempe, AZ

Sources for this page

Verify at the official NPI Registry.