MEDICARE: HOSPICE PROMISE OF MOHAVE 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	305S00000X	Point of Service

General Provider Information

NPI Number	:	1912443144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE PROMISE OF MOHAVE LLC

Provider Business Mailing Address
First Line	:	840 W UNIVERSITY DR STE 1
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-5529
Country	:	US
Telephone Number	:	480-422-6092
Fax Number	:	480-422-6093

Provider Business Practice Location Address
First Line	:	840 W UNIVERSITY DR STE 1
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-5529
Country	:	US
Telephone Number	:	480-422-6092
Fax Number	:	480-422-6093

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DEBORAH ANN HORNING
Credential	:	LPN
Telephone Number	:	623-792-0070

Provider Enumeration Date	:	01/11/2017
Last Update Date	:	03/17/2018

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