MEDICARE: PHOENICIAN 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		AZ

General Provider Information

NPI Number	:	1730624461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENICIAN HOSPICE LLC

Provider Business Mailing Address
First Line	:	5111 N SCOTTSDALE RD STE 204
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-7077
Country	:	US
Telephone Number	:	480-887-8993
Fax Number	:	480-887-8994

Provider Business Practice Location Address
First Line	:	5111 N SCOTTSDALE RD STE 204
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-7077
Country	:	US
Telephone Number	:	480-887-8993
Fax Number	:	480-887-8994

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	MR. SCOTT M. JOHNSON
Credential	:
Telephone Number	:	617-262-8455

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	06/29/2020

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Directions to “PHOENICIAN HOSPICE LLC ” Practice Location

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