Basic Information
| Provider Information | |||||||||
| NPI: | 1053609727 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SEASONS HOSPICE & PALLIATIVE CARE OF ARIZONA, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ACCENTCARE HOSPICE & PALLIATIVE CARE OF ARIZONA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 SHAFER CT | ||||||||
| Address2: | STE 700 | ||||||||
| City: | ROSEMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600184914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476921000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7720 N 16TH ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850207405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806061011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2011 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | SISCEL | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP LEGAL | ||||||||
| AuthorizedOfficialTelephone: | 2242210465 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | AZ | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 689505 | 05 | AZ | MEDICAID |