MEDICARE: CENTRA MANAGEMENT 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	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L21405248	OTHER	AZ	HOSPICE

General Provider Information

NPI Number	:	1588279673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRA MANAGEMENT SERVICES LLC

Provider Business Mailing Address
First Line	:	4530 E SHEA BLVD STE 142
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-6067
Country	:	US
Telephone Number	:	480-320-4733
Fax Number	:	888-920-7164

Provider Business Practice Location Address
First Line	:	4530 E SHEA BLVD STE 142
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-6067
Country	:	US
Telephone Number	:	480-320-4733
Fax Number	:	888-920-7164

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEFFERY SMITH
Credential	:
Telephone Number	:	480-320-4733

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	04/12/2022

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Directions to “CENTRA MANAGEMENT SERVICES LLC ” Practice Location

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