Provider Demographics
NPI:1326628512
Name:PASSION HEALTH LLC
Entity Type:Organization
Organization Name:PASSION HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:CICCIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-296-5429
Mailing Address - Street 1:2550 W UNION HILLS DRIVE
Mailing Address - Street 2:SUITE 350 OFFICE 317B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5187
Mailing Address - Country:US
Mailing Address - Phone:480-296-5429
Mailing Address - Fax:480-900-8525
Practice Address - Street 1:2550 W UNION HILLS DR STE 350
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5187
Practice Address - Country:US
Practice Address - Phone:480-296-5429
Practice Address - Fax:480-900-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty