Provider Demographics
NPI:1114123387
Name:EAST VALLEY HOSPICE P.L.C.
Entity Type:Organization
Organization Name:EAST VALLEY HOSPICE P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-895-5434
Mailing Address - Street 1:2152 S VINEYARD STE 117
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6881
Mailing Address - Country:US
Mailing Address - Phone:480-895-5434
Mailing Address - Fax:
Practice Address - Street 1:2152 S VINEYARD STE 117
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6881
Practice Address - Country:US
Practice Address - Phone:480-895-5434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031578Medicare Oscar/Certification