Healthcare Provider Details

I. General information

NPI: 1275295057
Provider Name (Legal Business Name): RIVER HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2021
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 S COUNTRY CLUB DR STE 109
MESA AZ
85210-6808
US

IV. Provider business mailing address

1930 S ALMA SCHOOL RD STE B201-B
MESA AZ
85210-3064
US

V. Phone/Fax

Practice location:
  • Phone: 623-328-9399
  • Fax:
Mailing address:
  • Phone: 623-328-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: ROBERT C BAYSAN
Title or Position: MEMBER/MANAGER
Credential: CO-OWNER
Phone: 623-328-9399