MEDICARE: EAST VALLEY HOSPICE P.L.C.

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	:	1114123387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST VALLEY HOSPICE P.L.C.

Provider Business Mailing Address
First Line	:	2152 S VINEYARD STE 117
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-6881
Country	:	US
Telephone Number	:	480-895-5434
Fax Number	:

Provider Business Practice Location Address
First Line	:	2152 S VINEYARD STE 117
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-6881
Country	:	US
Telephone Number	:	480-895-5434
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. KENT RAYMOND ALLEN
Credential	:	M.D.
Telephone Number	:	480-895-5434

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	12/14/2020

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