Provider Demographics
NPI:1225092760
Name:HIGHWAY CHRISTIAN HOSPICE INC
Entity Type:Organization
Organization Name:HIGHWAY CHRISTIAN HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-274-1952
Mailing Address - Street 1:67 E WELDON AVE
Mailing Address - Street 2:STE 317
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2045
Mailing Address - Country:US
Mailing Address - Phone:602-274-1952
Mailing Address - Fax:602-274-2338
Practice Address - Street 1:67 E WELDON AVE
Practice Address - Street 2:STE 317
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2045
Practice Address - Country:US
Practice Address - Phone:602-274-1952
Practice Address - Fax:602-274-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC1110251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
031540Medicare ID - Type Unspecified