Provider Demographics
NPI:1700320413
Name:AMERICAN PREMIER PALLIATIVE, LLC
Entity Type:Organization
Organization Name:AMERICAN PREMIER PALLIATIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTIMBASTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:623-206-7386
Mailing Address - Street 1:11070 N 24TH AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11070 N 24TH AVE STE 250
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4705
Practice Address - Country:US
Practice Address - Phone:623-206-7386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based