Healthcare Provider Details

I. General information

NPI: 1437186269
Provider Name (Legal Business Name): RCHP- SIERRA VISTA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 S MOORMAN AVE
SIERRA VISTA AZ
85635-2700
US

IV. Provider business mailing address

151 COLONIA DE SALUD STE. B
SIERRA VISTA AZ
85635-8223
US

V. Phone/Fax

Practice location:
  • Phone: 520-417-3080
  • Fax: 520-417-3219
Mailing address:
  • Phone: 520-417-3835
  • Fax: 520-417-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHSP-C0023
License Number StateAZ

VIII. Authorized Official

Name: TERRANCE DILLON
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7220