Healthcare Provider Details

I. General information

NPI: 1912861725
Provider Name (Legal Business Name): ENCORE HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 W INNOVATIVE DR STE 101H&I
PHOENIX AZ
85086-3846
US

IV. Provider business mailing address

3655 W ANTHEM WAY STE A109-386
ANTHEM AZ
85086-0430
US

V. Phone/Fax

Practice location:
  • Phone: 623-248-6636
  • Fax: 623-250-2371
Mailing address:
  • Phone: 623-248-6636
  • Fax: 623-250-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: AVA HOLLY CARLSON
Title or Position: CEO/OWNER
Credential:
Phone: 623-248-6636