Provider Demographics
NPI:1659970648
Name:AVRA HOSPICE CARE INC
Entity Type:Organization
Organization Name:AVRA HOSPICE CARE INC
Other - Org Name:ARIZONA LIFE HOSPICE - YAVAPAI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-379-3391
Mailing Address - Street 1:3177 CLEARWATER DR STE B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7272
Mailing Address - Country:US
Mailing Address - Phone:928-379-3391
Mailing Address - Fax:928-583-9775
Practice Address - Street 1:3177 CLEARWATER DR STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7272
Practice Address - Country:US
Practice Address - Phone:928-379-3391
Practice Address - Fax:928-583-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based