Provider Demographics
NPI:1568111201
Name:WINTERHAVEN HOSPICE, LLC
Entity Type:Organization
Organization Name:WINTERHAVEN HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-634-2915
Mailing Address - Street 1:1265 GAIL GARDNER WAY STE B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3425
Mailing Address - Country:US
Mailing Address - Phone:928-459-2235
Mailing Address - Fax:928-459-2234
Practice Address - Street 1:1265 GAIL GARDNER WAY STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3425
Practice Address - Country:US
Practice Address - Phone:928-459-2235
Practice Address - Fax:928-459-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based