Healthcare Provider Details

I. General information

NPI: 1831584127
Provider Name (Legal Business Name): A SERVANT'S HEART PALLIATIVE AND NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6380 E THOMAS RD STE 105
SCOTTSDALE AZ
85251-7073
US

IV. Provider business mailing address

6380 E THOMAS RD STE 105
SCOTTSDALE AZ
85251-7073
US

V. Phone/Fax

Practice location:
  • Phone: 480-771-3400
  • Fax: 480-304-3155
Mailing address:
  • Phone: 480-771-3400
  • Fax: 480-304-3155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: VALERIE KENWORTHY
Title or Position: REGIONAL VICE PRESIDEN
Credential:
Phone: 480-771-3400