Provider Demographics
NPI:1952589483
Name:RTA HOSPICE, INC.
Entity Type:Organization
Organization Name:RTA HOSPICE, INC.
Other - Org Name:RTA HOSPICE & PALLIATIVE CARE - BULLHEAD CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-970-8888
Mailing Address - Street 1:3500 BLUE LAKE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-1907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1225 HANCOCK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5948
Practice Address - Country:US
Practice Address - Phone:928-763-6433
Practice Address - Fax:928-763-6437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPENDING251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid
AZPENDINGMedicare Oscar/Certification