MEDICARE: WEST PALM VALLEY HOSPICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1003579244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST PALM VALLEY HOSPICE

Provider Business Mailing Address
First Line	:	4600 E WASHINGTON ST STE 367
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1903
Country	:	US
Telephone Number	:	602-370-1085
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 E WASHINGTON ST STE 367
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1903
Country	:	US
Telephone Number	:	602-370-1085
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASON CARTHEN
Credential	:
Telephone Number	:	602-370-1085

Provider Enumeration Date	:	10/14/2021
Last Update Date	:	10/14/2021

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Directions to “WEST PALM VALLEY HOSPICE ” Practice Location

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