Provider Demographics
NPI:1245778323
Name:COPPER BASIN HEALTHCARE, INC.
Entity Type:Organization
Organization Name:COPPER BASIN HEALTHCARE, INC.
Other - Org Name:THE PINES HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:6719 E 2ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2661
Mailing Address - Country:US
Mailing Address - Phone:928-632-0111
Mailing Address - Fax:928-632-0333
Practice Address - Street 1:6719 E 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2661
Practice Address - Country:US
Practice Address - Phone:928-632-0111
Practice Address - Fax:928-632-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based