Provider Demographics
NPI:1780638379
Name:SUN HEALTH HOSPICE CARE SERVICES
Entity Type:Organization
Organization Name:SUN HEALTH HOSPICE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-876-5352
Mailing Address - Street 1:PO BOX 29892
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9892
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12740 N PLAZA DEL RIO BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-8100
Practice Address - Country:US
Practice Address - Phone:623-815-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC-3722251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based