MEDICARE: JOURNEY 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

General Provider Information

NPI Number	:	1912408907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY HOSPICE LLC

Provider Business Mailing Address
First Line	:	1 W CAMPBELL AVE APT 2081
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-4915
Country	:	US
Telephone Number	:	602-885-3499
Fax Number	:

Provider Business Practice Location Address
First Line	:	3043 N 33RD DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-5204
Country	:	US
Telephone Number	:	602-885-3499
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / ADMINISTRATOR
Name	:	MRS. LAURIE LYNN MARTINEZ
Credential	:
Telephone Number	:	602-885-3499

Provider Enumeration Date	:	02/24/2018
Last Update Date	:	02/24/2018

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Directions to “JOURNEY HOSPICE LLC ” Practice Location

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