Healthcare Provider Details

I. General information

NPI: 1356614754
Provider Name (Legal Business Name): AEGIS HOSPICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 E BASELINE RD STE 129
MESA AZ
85209-5006
US

IV. Provider business mailing address

7227 E BASELINE RD STE 129
MESA AZ
85209-5006
US

V. Phone/Fax

Practice location:
  • Phone: 480-219-4790
  • Fax: 480-584-5871
Mailing address:
  • Phone: 480-219-4790
  • Fax: 480-584-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BENJAMIN LARSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-754-4962