Provider Demographics
NPI:1770250102
Name:AVESTA HOSPICE INC
Entity Type:Organization
Organization Name:AVESTA HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:KELLOGG
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-350-9961
Mailing Address - Street 1:312 N ALMA SCHOOL RD STE 14K
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4354
Mailing Address - Country:US
Mailing Address - Phone:602-820-8168
Mailing Address - Fax:602-753-9968
Practice Address - Street 1:312 N ALMA SCHOOL RD STE 14K
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4354
Practice Address - Country:US
Practice Address - Phone:602-820-8168
Practice Address - Fax:602-753-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based