| Organization Name: | TRADITIONAL HOME CARE |
| NPI Number: | 1669728713 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LULA M NEZ (OWNER) |
| Mailing Address: | 1/4 Mile N. Two Story Rd. Ra #31 St. Michaels |
| State: | AZ US |
| Postal Code: | 86511 |
| Phone Number: | 9288715021 |
| Fax Number: | 9288103998 |
| NPI Enumeration Date: | 07/26/2012 |
| NPI Last Update Date: | 07/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | 415780 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |