Provider Demographics
NPI:1558328583
Name:NORTHLAND HOSPICE & PALLIATIVE CARE INC
Entity Type:Organization
Organization Name:NORTHLAND HOSPICE & PALLIATIVE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTHOLOMEW
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:928-779-1227
Mailing Address - Street 1:P.O. BOX 977
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:83002-0997
Mailing Address - Country:US
Mailing Address - Phone:928-779-1227
Mailing Address - Fax:928-779-5884
Practice Address - Street 1:452 N. SWITZER CANYON DR.
Practice Address - Street 2:STE. A
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4855
Practice Address - Country:US
Practice Address - Phone:928-779-1227
Practice Address - Fax:928-779-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC0007251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110495Medicaid
AZ726185Medicaid
AZ031512Medicare ID - Type UnspecifiedPROVIDER ID