Provider Demographics
NPI:1538443569
Name:CORNERSTONE HOSPICE ARIZONA, LLC
Entity type:Organization
Organization Name:CORNERSTONE HOSPICE ARIZONA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-282-5800
Mailing Address - Street 1:7310 N 16TH ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5258
Mailing Address - Country:US
Mailing Address - Phone:602-263-0925
Mailing Address - Fax:602-263-0929
Practice Address - Street 1:7310 N 16TH ST
Practice Address - Street 2:SUITE 230
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5258
Practice Address - Country:US
Practice Address - Phone:602-263-0925
Practice Address - Fax:602-263-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC5224251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031554Medicare Oscar/Certification