MEDICARE: RTA HOSPICE, LLC

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	315D00000X	Inpatient Hospice
2	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568492395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RTA HOSPICE, LLC

Provider Business Mailing Address
First Line	:	10 CADILLAC DR
Second Line	:	SUITE 400
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5078
Country	:	US
Telephone Number	:	615-425-5407
Fax Number	:	615-373-4457

Provider Business Practice Location Address
First Line	:	511 S MUD SPRINGS ROAD
Second Line	:
City	:	PAYSON
State	:	AZ
Zip	:	85541-5747
Country	:	US
Telephone Number	:	928-472-6340
Fax Number	:	928-468-2120

Authorized Official
Title or Position	:	SVP GENERAL COUNSEL
Name	:	RUSSELL ADKINS
Credential	:
Telephone Number	:	615-309-5668

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	03/21/2022

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Directions to “RTA HOSPICE, LLC ” Practice Location

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