Healthcare Provider Details

I. General information

NPI: 1326092925
Provider Name (Legal Business Name): HOSPICE OF YUMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 S 8TH AVE
YUMA AZ
85364-5517
US

IV. Provider business mailing address

1824 S 8TH AVE
YUMA AZ
85364-5517
US

V. Phone/Fax

Practice location:
  • Phone: 928-343-2222
  • Fax: 928-217-2260
Mailing address:
  • Phone: 928-343-2222
  • Fax: 928-217-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberHSPC0003
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberHSPC0003
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHSPC0003
License Number StateAZ

VIII. Authorized Official

Name: MR. JOHN ERNEST WILLIAMS
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW
Phone: 928-343-2222