Provider Demographics
NPI:1407425077
Name:STONE CREEK HOSPICE LLC
Entity Type:Organization
Organization Name:STONE CREEK HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGING
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:ARMEN
Authorized Official - Last Name:ABRAMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-734-4613
Mailing Address - Street 1:11811 N TATUM BLVD STE 3031-50
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1614
Mailing Address - Country:US
Mailing Address - Phone:602-734-4613
Mailing Address - Fax:602-649-1263
Practice Address - Street 1:11811 N TATUM BLVD STE 3031-50
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1614
Practice Address - Country:US
Practice Address - Phone:602-734-4613
Practice Address - Fax:602-649-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based