1992714778 NPI number — HOSPICE OF ARIZONA, LC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992714778 NPI number — HOSPICE OF ARIZONA, LC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF ARIZONA, LC
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:
1992714778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 N LAURA ST
Provider Second Line Business Mailing Address:
SUITE 1800
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32202-3664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-493-6745
Provider Business Mailing Address Fax Number:
904-262-4804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19820 N 7TH AVE
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85027-4736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-678-1313
Provider Business Practice Location Address Fax Number:
602-242-2178
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOGLE
Authorized Official First Name:
RICH
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
904-493-6745

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  HSPC0050 , 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: 193475 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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