Provider Demographics
NPI:1104365477
Name:FOUNTAIN HILLS HOSPICE, LLC
Entity Type:Organization
Organization Name:FOUNTAIN HILLS HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRIGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KEPENYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-500-7394
Mailing Address - Street 1:17007 E COLONY DR STE 107
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-4672
Mailing Address - Country:US
Mailing Address - Phone:480-500-7394
Mailing Address - Fax:480-500-7996
Practice Address - Street 1:1801 S JENTILLY LN STE A10
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5738
Practice Address - Country:US
Practice Address - Phone:888-900-4543
Practice Address - Fax:480-500-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-18
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based