Provider Demographics
NPI:1831662402
Name:ARIZONA HOSPICE FLAGSTAFF, LLC
Entity Type:Organization
Organization Name:ARIZONA HOSPICE FLAGSTAFF, LLC
Other - Org Name:HAVEN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-257-4285
Mailing Address - Street 1:885 PENNIMAN AVE UNIT 6426
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-7722
Mailing Address - Country:US
Mailing Address - Phone:734-560-8953
Mailing Address - Fax:
Practice Address - Street 1:670 E 32ND ST STE 9A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-3576
Practice Address - Country:US
Practice Address - Phone:928-420-8880
Practice Address - Fax:954-337-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based