=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104871532
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISTACARE USA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1713 DAWSON RD
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31707-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-430-7537
-----------------------------------------------------
Fax | 229-430-9846
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4800 N SCOTTSDALE RD SUITE 5000
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251-7630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-648-4545
-----------------------------------------------------
Fax | 480-648-4550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. RICHARD R SLAGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-648-4545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 047-223-H
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------