Provider Demographics
NPI:1588043533
Name:SOLACE HOSPICE, LLC.
Entity Type:Organization
Organization Name:SOLACE HOSPICE, LLC.
Other - Org Name:SOLACE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMASZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDZIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-204-0258
Mailing Address - Street 1:16841 N 31ST AVE STE 161
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3080
Mailing Address - Country:US
Mailing Address - Phone:602-888-7037
Mailing Address - Fax:
Practice Address - Street 1:16841 N 31ST AVE STE 161
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3080
Practice Address - Country:US
Practice Address - Phone:602-888-7037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based