Provider Demographics
NPI:1932827821
Name:STONERIDGE PALLIATIVE LLC
Entity Type:Organization
Organization Name:STONERIDGE PALLIATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-205-3331
Mailing Address - Street 1:20860 N TATUM BLVD STE 300-332
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4274
Mailing Address - Country:US
Mailing Address - Phone:480-306-8655
Mailing Address - Fax:888-408-0608
Practice Address - Street 1:20860 N TATUM BLVD STE 300-332
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4274
Practice Address - Country:US
Practice Address - Phone:480-306-8655
Practice Address - Fax:888-408-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based