Basic Information
| Provider Information | |||||||||
| NPI: | 1164611323 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALOR HOSPICECARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 E RIVER RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857185993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206153996 | ||||||||
| FaxNumber: | 5206153998 | ||||||||
| Practice Location | |||||||||
| Address1: | 1048 E FRY BLVD | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856351839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204589450 | ||||||||
| FaxNumber: | 5204589455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2007 | ||||||||
| LastUpdateDate: | 05/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | ROWE | ||||||||
| AuthorizedOfficialFirstName: | NATASHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5206153996 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | HSPC3739 | AZ | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 965022 | 05 | AZ | MEDICAID |