Provider Demographics
NPI:1922695121
Name:SKY HOSPICE INC
Entity Type:Organization
Organization Name:SKY HOSPICE INC
Other - Org Name:ARIZONA LIFE HOSPICE - MARICOPA
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:480-888-5609
Mailing Address - Street 1:4824 E BASELINE RD STE 133
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4680
Mailing Address - Country:US
Mailing Address - Phone:480-708-0829
Mailing Address - Fax:480-556-1403
Practice Address - Street 1:4824 E BASELINE RD STE 133
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4680
Practice Address - Country:US
Practice Address - Phone:480-708-0829
Practice Address - Fax:480-556-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based