Provider Demographics
NPI:1659433308
Name:SOJOURN CARE OF ARIZONA, INC.
Entity Type:Organization
Organization Name:SOJOURN CARE OF ARIZONA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:480-905-1346
Mailing Address - Street 1:7975 N HAYDEN RD
Mailing Address - Street 2:SUITE A208
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3246
Mailing Address - Country:US
Mailing Address - Phone:480-905-1346
Mailing Address - Fax:480-905-1352
Practice Address - Street 1:7975 N HAYDEN RD
Practice Address - Street 2:SUITE A208
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3246
Practice Address - Country:US
Practice Address - Phone:480-905-1346
Practice Address - Fax:480-905-1352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC3846251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03-1567Medicare ID - Type Unspecified