Provider Demographics
NPI:1205185170
Name:COPPER COMMUNITIES HOSPICE, LLC
Entity Type:Organization
Organization Name:COPPER COMMUNITIES HOSPICE, LLC
Other - Org Name:COPPER COMMUNITIES PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-717-4751
Mailing Address - Street 1:1640 S STAPLEY DR
Mailing Address - Street 2:STE. 245
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6664
Mailing Address - Country:US
Mailing Address - Phone:480-383-8599
Mailing Address - Fax:
Practice Address - Street 1:1640 S STAPLEY DR
Practice Address - Street 2:STE. 245
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6664
Practice Address - Country:US
Practice Address - Phone:480-383-8599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty