1689808156 NPI number — HOSPICE OF SCOTTSDALE

Table of content: CRYSTAL YVETTE BARRERA LCSW (NPI 1902049240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689808156 NPI number — HOSPICE OF SCOTTSDALE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF SCOTTSDALE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LEGACY HOSPICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689808156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4237 N CRAFTSMAN CT
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85251-3201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-723-3400
Provider Business Mailing Address Fax Number:
480-423-6852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4237 N CRAFTSMAN CT
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85251-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-723-3400
Provider Business Practice Location Address Fax Number:
480-423-6852
Provider Enumeration Date:
05/12/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ASBURY
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
TOBIAS
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
480-423-3400

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  HSPC4610 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)