Healthcare Provider Details

I. General information

NPI: 1831655760
Provider Name (Legal Business Name): RTA HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W 24TH ST STE 15
YUMA AZ
85364-8373
US

IV. Provider business mailing address

10 CADILLAC DR STE 400
BRENTWOOD TN
37027-1001
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-6100
  • Fax: 928-317-0311
Mailing address:
  • Phone: 615-377-7022
  • Fax: 615-373-4457

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
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL ADKINS
Title or Position: SVP GENERAL COUNSEL
Credential:
Phone: 615-309-5668