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NPI Code Detail

MEDICARE: LIBERTY HOSPICE LLC

MEDICARE: LIBERTY 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
1251G00000XCommunity Based Hospice Care AgencyHSPC7062AZ

General Provider Information

NPI Number : 1639440753
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIBERTY HOSPICE LLC
Provider Business Mailing Address
First Line : 11811 N TATUM BLVD
Second Line : SUITE 3031
City : PHOENIX
State : AZ
Zip : 85028-1614
Country : US
Telephone Number : 602-456-9993
Fax Number : 602-456-9993
Provider Business Practice Location Address
First Line : 11811 N TATUM BLVD STE 3031
Second Line :
City : PHOENIX
State : AZ
Zip : 85028-1621
Country : US
Telephone Number : 602-456-9993
Fax Number : 602-456-9993
Authorized Official
Title or Position : ADMINISTRATOR
Name : DIANNA BAKER
Credential :
Telephone Number : 602-456-9993
Provider Enumeration Date : 01/20/2012
Last Update Date : 04/28/2015

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Directions to “LIBERTY HOSPICE LLC ” Practice Location

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