Provider Demographics
NPI:1013698885
Name:OAKRIDGE HOSPICE, LLC
Entity Type:Organization
Organization Name:OAKRIDGE HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:DALDALYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-508-8588
Mailing Address - Street 1:13416 N 32ND ST STE 109B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-6000
Mailing Address - Country:US
Mailing Address - Phone:480-508-8588
Mailing Address - Fax:
Practice Address - Street 1:13416 N 32ND ST STE 109B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-6000
Practice Address - Country:US
Practice Address - Phone:480-508-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based