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General NPI Number Information
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NPI Number | 1649254517
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Entity Type | Organization
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Legal Business Name | HOSPICE OF HAVASU, INC.
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 232 LONDON BRIDGE RD BLDG A
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-4647
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Country | US
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Telephone | 928-453-2111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 597
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86405-0597
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Country | US
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Telephone | 928-453-2111
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DANIEL MATHEWS
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Credential |
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Telephone | 928-453-2111
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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 | HSPC0011
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License Number State | AZ
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