1831175249 NPI number — HOSPICE FAMILY CARE, INC.

Table of content: (NPI 1831175249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831175249 NPI number — HOSPICE FAMILY CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE FAMILY CARE, INC.
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:
Provider Other Organization Name Type Code:
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:
1831175249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
655 BRAWLEY SCHOOL RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MOORESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28117-9125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-664-2876
Provider Business Mailing Address Fax Number:
704-664-1306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3195 STILLWATER DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86305-7171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-541-1740
Provider Business Practice Location Address Fax Number:
877-775-1694
Provider Enumeration Date:
12/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KLEBERG
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF LEGAL AFFAIRS
Authorized Official Telephone Number:
704-664-2876

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  HSPC0060 , 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)

  • Identifier: 408600 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0700420 . This is a "BC/BS OF ARIZONA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: IZ0241 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".