Provider Demographics
NPI:1467409219
Name:YRMC HOSPICE
Entity Type:Organization
Organization Name:YRMC HOSPICE
Other - Org Name:YAVAPAI COMMUNITY HOSPITAL ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:BRISTOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-771-5691
Mailing Address - Street 1:3262 N WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2255
Mailing Address - Country:US
Mailing Address - Phone:928-759-5900
Mailing Address - Fax:928-759-5982
Practice Address - Street 1:3262 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2255
Practice Address - Country:US
Practice Address - Phone:928-759-5900
Practice Address - Fax:928-759-5982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC0008251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ179467Medicaid
AZAZ0700600OtherBLUE CROSS PROVIDER
AZ031506Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER