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General NPI Number Information
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NPI Number | 1306152152
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Entity Type | Organization
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Legal Business Name | GRACE HOSPICE OF ARIZONA, INC.
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 02/03/2016
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Provider Practice Location Address
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Address Line | 10631 PARAMOUNT BLVD
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City | DOWNEY
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State | CA
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Zip | 90241-3303
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Country | US
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Telephone | 562-904-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 5314 S YALE AVE SUITE 420
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City | TULSA
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State | OK
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Zip | 74135-6256
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Country | US
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Telephone | 918-289-2553
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Fax |
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Authorized Official
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Title or Position | SECRETARY / TREASURER
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Name | MR. ROGER BRUHN
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Credential |
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Telephone | 918-894-3487
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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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