MEDICARE: HOSPICE OF COCONINO COUNTY, 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1710607965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE OF COCONINO COUNTY, LLC

Provider Business Mailing Address
First Line	:	5676 E CHENEY DR
Second Line	:
City	:	PARADISE VALLEY
State	:	AZ
Zip	:	85253-3076
Country	:	US
Telephone Number	:	602-622-1848
Fax Number	:	928-440-1128

Provider Business Practice Location Address
First Line	:	15 N SAN FRANCISCO ST STE 206
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-5229
Country	:	US
Telephone Number	:	602-622-1848
Fax Number	:	928-440-1128

Authorized Official
Title or Position	:	CEO
Name	:	CYNTHIA DIANE LAMB
Credential	:
Telephone Number	:	602-622-1848

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	10/06/2025

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