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General NPI Number Information
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NPI Number | 1841696911
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Entity Type | Organization
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Legal Business Name | EVERGREEN HOSPICE AND PALLIATIVE CARE
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 454 W WHITE MOUNTAIN BLVD SUITE 7
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City | LAKESIDE
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State | AZ
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Zip | 85929-6663
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Country | US
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Telephone | 602-549-1905
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Fax | 888-432-7480
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Provider Business Mailing Address
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Address Line | PO BOX 2146
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City | PINETOP
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State | AZ
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Zip | 85935-2146
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Country | US
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Telephone | 602-218-0811
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL DIRECTOR
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Name | DR. MARC ALAN BAUDER
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Credential | MD ABFM/GERIATRICS
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Telephone | 602-218-0811
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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 | AZ
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