Healthcare Provider Details

I. General information

NPI: 1922747559
Provider Name (Legal Business Name): AARONDALE HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2898 W CAPRIANA DR
MERIDIAN ID
83646-2687
US

IV. Provider business mailing address

2898 W CAPRIANA DR
MERIDIAN ID
83646-2687
US

V. Phone/Fax

Practice location:
  • Phone: 714-720-8123
  • Fax:
Mailing address:
  • Phone: 714-720-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: ALEX MICHAEL MARTINEZ
Title or Position: OWNER
Credential:
Phone: 714-720-8123