Provider Demographics
NPI:1588279673
Name:CENTRA MANAGEMENT SERVICES LLC
Entity type:Organization
Organization Name:CENTRA MANAGEMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-320-4733
Mailing Address - Street 1:4530 E SHEA BLVD STE 142
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6067
Mailing Address - Country:US
Mailing Address - Phone:480-320-4733
Mailing Address - Fax:888-920-7164
Practice Address - Street 1:4530 E SHEA BLVD STE 142
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6067
Practice Address - Country:US
Practice Address - Phone:480-320-4733
Practice Address - Fax:888-920-7164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZL21405248OtherHOSPICE