MEDICARE: GOLDEN CANYON HOSPICE, INC

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

General Provider Information

NPI Number	:	1871251918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN CANYON HOSPICE, INC

Provider Business Mailing Address
First Line	:	101 W RENNER RD STE 420
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-2022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 W INA RD STE 109
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1975
Country	:	US
Telephone Number	:	520-467-4455
Fax Number	:	520-467-4455

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DONNIE MABERRY
Credential	:
Telephone Number	:	972-468-8070

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	05/12/2026

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Directions to “GOLDEN CANYON HOSPICE, INC ” Practice Location

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