MEDICARE: SOLARIS HOSPICE AZ, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HSPC9110	OTHER	AZ	STATE LICENSURE

General Provider Information

NPI Number	:	1275027526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLARIS HOSPICE AZ, INC.

Provider Business Mailing Address
First Line	:	2250 S FM 51 STE 400
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-3767
Country	:	US
Telephone Number	:	940-627-1011
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 IRON SPRINGS RD
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-1622
Country	:	US
Telephone Number	:	940-627-1011
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	LEANNE PETERSON
Credential	:
Telephone Number	:	940-627-1011

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	10/01/2021

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Directions to “SOLARIS HOSPICE AZ, INC. ” Practice Location

Language	Start Address	Practice Location

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