Your Health Home Pllc | |
2035 Mesquite Ave Suite C Lake Havasu City AZ 86403-5894 | |
(928) 680-3343 | |
(928) 680-3342 |
Full Name | Your Health Home Pllc |
---|---|
Speciality | Internal Medicine |
Location | 2035 Mesquite Ave, Lake Havasu City, Arizona |
Authorized Official Name and Position | Robert D Peterson (OWNER/MEMBER) |
Authorized Official Contact | 9286803343 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Your Health Home Pllc Po Box 1969 Lake Havasu City AZ 86405-1969 Ph: (928) 680-3343 | Your Health Home Pllc 2035 Mesquite Ave Suite C Lake Havasu City AZ 86403-5894 Ph: (928) 680-3343 |
NPI Number | 1609207075 |
---|---|
Provider Enumeration Date | 12/10/2013 |
Last Update Date | 03/13/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609207075 | NPI | - | NPPES |
P-18894563 | Other | AZ | PLLC REGISTRATION NUMBER |
885211 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 48485 (Arizona) | Primary |
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