Provider Demographics
NPI:1659719771
Name:PRINCE OF PEACE HOSPICE & PALLIATIVE CARE
Entity Type:Organization
Organization Name:PRINCE OF PEACE HOSPICE & PALLIATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARINDER
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:TAKYAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-429-4043
Mailing Address - Street 1:9341 E MCKELLIPS RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-2632
Mailing Address - Country:US
Mailing Address - Phone:520-429-4043
Mailing Address - Fax:
Practice Address - Street 1:660 S PINAL PKWY APT 106
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-9726
Practice Address - Country:US
Practice Address - Phone:520-448-8483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34308315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ948416Medicaid