MEDICARE: ALPHA OMEGA VENTANA HOSPICE LLC

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	:	1215428461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA OMEGA VENTANA HOSPICE LLC

Provider Business Mailing Address
First Line	:	9800 S MONROE ST # 809
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-4419
Country	:	US
Telephone Number	:	801-849-0486
Fax Number	:	801-849-0476

Provider Business Practice Location Address
First Line	:	5575 RUFFIN RD STE 250
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1387
Country	:	US
Telephone Number	:	619-900-0335
Fax Number	:	619-900-0365

Authorized Official
Title or Position	:	CIO
Name	:	TYLER GODFREY
Credential	:
Telephone Number	:	801-849-0486

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	05/07/2025

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