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General NPI Number Information
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NPI Number | 1093415739
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Entity Type | Organization
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Legal Business Name | KM234
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Dates
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Enumeration Date | 03/09/2023
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 15 N CENTRAL ST # D
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City | COLORADO CITY
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State | AZ
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Zip | 86021-6141
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Country | US
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Telephone | 435-879-3031
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Fax |
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Provider Business Mailing Address
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Address Line | 1459 W 540 N
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City | HURRICANE
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State | UT
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Zip | 84737-1414
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Country | US
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Telephone | 801-318-1420
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAHOGANI MADRIGAL
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Credential | MBA
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Telephone | 801-318-1420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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