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General NPI Number Information
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NPI Number | 1104389535
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Entity Type | Organization
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Legal Business Name | ST THERESA HOSPICE LLC
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 3003 HIGHWAY 95 STE 21
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-7896
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Country | US
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Telephone | 928-605-4009
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Fax | 928-940-2057
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Provider Business Mailing Address
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Address Line | 746 E WINCHESTER ST STE 200
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City | MURRAY
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State | UT
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Zip | 84107-8513
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Country | US
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Telephone | 801-485-6166
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Fax | 801-531-1949
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | BREEZIE LISKEY
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Credential |
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Telephone | 801-485-6166
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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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