Healthcare Provider Details

I. General information

NPI: 1730661729
Provider Name (Legal Business Name): IHOSPICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14780 W MOUNTAIN VIEW BLVD STE 110
SURPRISE AZ
85374-7280
US

IV. Provider business mailing address

14780 W MOUNTAIN VIEW BLVD STE 110
SURPRISE AZ
85374-7280
US

V. Phone/Fax

Practice location:
  • Phone: 623-374-7774
  • Fax:
Mailing address:
  • Phone: 623-374-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY HUGHES
Title or Position: DIRECTOR
Credential:
Phone: 623-374-7774