Provider Demographics
NPI:1710697750
Name:ANTHEM EAST LLC
Entity Type:Organization
Organization Name:ANTHEM EAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-716-7745
Mailing Address - Street 1:105 N PASADENA ST STE B
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5013
Mailing Address - Country:US
Mailing Address - Phone:480-716-7745
Mailing Address - Fax:
Practice Address - Street 1:105 N PASADENA ST STE B
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5013
Practice Address - Country:US
Practice Address - Phone:480-716-7745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based