MEDICARE: SUN VALLEY 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	:	1932266657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN VALLEY HOSPICE LLC

Provider Business Mailing Address
First Line	:	4555 E INVERNESS AVE
Second Line	:	STE 102
City	:	MESA
State	:	AZ
Zip	:	85206-4630
Country	:	US
Telephone Number	:	480-558-2002
Fax Number	:

Provider Business Practice Location Address
First Line	:	4555 E INVERNESS AVE
Second Line	:	STE 102
City	:	MESA
State	:	AZ
Zip	:	85206-4630
Country	:	US
Telephone Number	:	480-558-2002
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MS. LISA HANNE
Credential	:	RN
Telephone Number	:	480-633-1555

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/10/2007

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