Provider Demographics
NPI:1376984302
Name:ACCORD HOSPICE OF THE WHITE MOUNTAINS, LLC
Entity Type:Organization
Organization Name:ACCORD HOSPICE OF THE WHITE MOUNTAINS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DIEDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-920-8875
Mailing Address - Street 1:5300 S SUTTER DR BLDG C
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-8054
Mailing Address - Country:US
Mailing Address - Phone:928-271-8013
Mailing Address - Fax:801-337-1889
Practice Address - Street 1:5300 S SUTTER DR BLDG C
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-8054
Practice Address - Country:US
Practice Address - Phone:928-271-8013
Practice Address - Fax:801-337-1889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCORD HOME HEALTH AND HOSPICE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-05
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC5741251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based