MEDICARE: LNA CNA MEDCIAL SERVICES 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	315D00000X	Inpatient Hospice

General Provider Information

NPI Number	:	1578274940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LNA CNA MEDCIAL SERVICES LLC

Provider Business Mailing Address
First Line	:	6825 S 7TH ST UNIT 91312
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-5440
Country	:	US
Telephone Number	:	602-314-1623
Fax Number	:

Provider Business Practice Location Address
First Line	:	6825 S 7TH ST UNIT 91312
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-5440
Country	:	US
Telephone Number	:	602-314-1623
Fax Number	:

Authorized Official
Title or Position	:	MEMBER-MANAGER
Name	:	EDWARD LONG
Credential	:	LNA, EMT
Telephone Number	:	602-314-1623

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	12/07/2022

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Directions to “LNA CNA MEDCIAL SERVICES LLC ” Practice Location

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