Provider Demographics
NPI:1235489147
Name:HOSPICE OF THE SOUTHWEST - WEST VALLEY, LLC
Entity Type:Organization
Organization Name:HOSPICE OF THE SOUTHWEST - WEST VALLEY, LLC
Other - Org Name:TUCSON COMMUNITY 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 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:STE D-205
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3625
Mailing Address - Country:US
Mailing Address - Phone:520-230-4450
Mailing Address - Fax:520-230-4451
Practice Address - Street 1:5055 E BROADWAY BLVD
Practice Address - Street 2:STE D-205
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3625
Practice Address - Country:US
Practice Address - Phone:520-230-4450
Practice Address - Fax:520-230-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
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
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty