Provider Demographics
NPI:1912329533
Name:AMHA HOSPICE LLC
Entity Type:Organization
Organization Name:AMHA HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-359-3998
Mailing Address - Street 1:2577 W QUEEN CREEK RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0913
Mailing Address - Country:US
Mailing Address - Phone:480-359-3998
Mailing Address - Fax:480-385-6785
Practice Address - Street 1:2577 W QUEEN CREEK RD STE 200A
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-0913
Practice Address - Country:US
Practice Address - Phone:480-359-3998
Practice Address - Fax:480-385-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ032584Medicaid
AZHSPC6237OtherAZ DEPARTMENT OF HEALTH