Healthcare Provider Details

I. General information

NPI: 1659719771
Provider Name (Legal Business Name): PRINCE OF PEACE HOSPICE & PALLIATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S PINAL PKWY APT 106
FLORENCE AZ
85132-9726
US

IV. Provider business mailing address

9341 E MCKELLIPS RD
MESA AZ
85207-2632
US

V. Phone/Fax

Practice location:
  • Phone: 520-448-8483
  • Fax:
Mailing address:
  • Phone: 520-429-4043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number34308
License Number StateAZ

VIII. Authorized Official

Name: DR. HARINDER KUMAR TAKYAR
Title or Position: OWNER
Credential: M.D.
Phone: 520-429-4043