Provider Demographics
NPI:1740099860
Name:STATE 48 HOSPICE OF PHOENIX LLC
Entity type:Organization
Organization Name:STATE 48 HOSPICE OF PHOENIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-306-7078
Mailing Address - Street 1:3200 N HAYDEN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6766
Mailing Address - Country:US
Mailing Address - Phone:702-445-1354
Mailing Address - Fax:
Practice Address - Street 1:3200 N HAYDEN RD STE 105B
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6766
Practice Address - Country:US
Practice Address - Phone:480-306-7078
Practice Address - Fax:480-306-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-03
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based