MEDICARE: HOSPICE PROMISE 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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770917692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE PROMISE LLC

Provider Business Mailing Address
First Line	:	17235 N 75TH AVE STE E175
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-0870
Country	:	US
Telephone Number	:	623-209-7003
Fax Number	:	623-209-7008

Provider Business Practice Location Address
First Line	:	17235 N 75TH AVE STE E175
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-0870
Country	:	US
Telephone Number	:	623-209-7003
Fax Number	:	623-209-7008

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. DEBORAH HORNING
Credential	:	LPN
Telephone Number	:	623-792-0070

Provider Enumeration Date	:	08/27/2013
Last Update Date	:	11/04/2022

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Directions to “HOSPICE PROMISE LLC ” Practice Location

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