1952589483 NPI number — RTA HOSPICE, INC.

Table of content: (NPI 1952589483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952589483 NPI number — RTA HOSPICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RTA HOSPICE, 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:
6
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:
1952589483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 BLUE LAKE DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35243-1907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 HANCOCK RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BULLHEAD CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86442-5948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-763-6433
Provider Business Practice Location Address Fax Number:
928-763-6437
Provider Enumeration Date:
02/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HUNTER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
BRADLEY
Authorized Official Title or Position:
SENIOR VICE-PRESIDENT
Authorized Official Telephone Number:
205-970-8888

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  PENDING , 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: PENDING , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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