Provider Demographics
NPI:1104389535
Name:ST THERESA HOSPICE LLC
Entity Type:Organization
Organization Name:ST THERESA HOSPICE LLC
Other - Org Name:CANYON HOME CARE & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BREEZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LISKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-485-6166
Mailing Address - Street 1:450 S 900 E STE 100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2983
Mailing Address - Country:US
Mailing Address - Phone:801-485-6166
Mailing Address - Fax:801-531-1949
Practice Address - Street 1:2031 HWAY 95 STE 1
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6004
Practice Address - Country:US
Practice Address - Phone:480-597-3661
Practice Address - Fax:480-597-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based