Provider Demographics
NPI:1982971255
Name:HOSPICE OF THE SOUTHWEST, LLC
Entity Type:Organization
Organization Name:HOSPICE OF THE SOUTHWEST, LLC
Other - Org Name:BRIDGES PALLIATIVE CARE & TRANSITION PROGRAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-456-9300
Mailing Address - Street 1:450 N DOBSON RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-5277
Mailing Address - Country:US
Mailing Address - Phone:480-456-9300
Mailing Address - Fax:480-456-9696
Practice Address - Street 1:450 N DOBSON RD
Practice Address - Street 2:SUITE 108
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5277
Practice Address - Country:US
Practice Address - Phone:480-305-5132
Practice Address - Fax:480-456-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Single Specialty