Provider Demographics
NPI:1730624461
Name:PHOENICIAN HOSPICE LLC
Entity type:Organization
Organization Name:PHOENICIAN HOSPICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-262-8455
Mailing Address - Street 1:5111 N SCOTTSDALE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-7077
Mailing Address - Country:US
Mailing Address - Phone:480-887-8993
Mailing Address - Fax:480-887-8994
Practice Address - Street 1:5111 N SCOTTSDALE RD STE 204
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7077
Practice Address - Country:US
Practice Address - Phone:480-887-8993
Practice Address - Fax:480-887-8994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based