Healthcare Provider Details

I. General information

NPI: 1871997072
Provider Name (Legal Business Name): V A HOSPICE 2 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5287 S HIGHWAY 95 SUITE H
FORT MOHAVE AZ
86426-9220
US

IV. Provider business mailing address

6718 W GREENWAY RD SUITE 208
PEORIA AZ
85381-4583
US

V. Phone/Fax

Practice location:
  • Phone: 844-824-3577
  • Fax: 844-329-8682
Mailing address:
  • Phone: 844-824-3577
  • Fax: 824-329-8682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHSPC6831
License Number StateAZ

VIII. Authorized Official

Name: ARMEN GHADIMIAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 844-824-3577