Healthcare Provider Details

I. General information

NPI: 1861969255
Provider Name (Legal Business Name): ARIZONA HOSPICE SCOTTSDALE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15551 N GREENWAY HAYDEN LOOP STE 155
SCOTTSDALE AZ
85260-1225
US

IV. Provider business mailing address

885 PENNIMAN AVE UNIT 6426
PLYMOUTH MI
48170-7722
US

V. Phone/Fax

Practice location:
  • Phone: 888-752-8055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRISTI JACKSON
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential:
Phone: 941-257-4285