Provider Demographics
NPI:1992030779
Name:COPPER COMMUNITIES HOSPICE, LLC
Entity Type:Organization
Organization Name:COPPER COMMUNITIES HOSPICE, LLC
Other - Org Name:AVIANT HOSPICE PHOENIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-717-4751
Mailing Address - Street 1:2430 W RAY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3552
Mailing Address - Country:US
Mailing Address - Phone:480-383-8599
Mailing Address - Fax:480-398-1620
Practice Address - Street 1:1400 N GILBERT RD STE H
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2321
Practice Address - Country:US
Practice Address - Phone:480-398-2411
Practice Address - Fax:480-664-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-12
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC4796251G00000X
AZHSPC5322251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ583314Medicaid
AZ03-1591Medicare UPIN