Basic Information
| Provider Information | |||||||||
| NPI: | 1831175249 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPICE FAMILY CARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 BRAWLEY SCHOOL RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281179125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046642876 | ||||||||
| FaxNumber: | 7046641306 | ||||||||
| Practice Location | |||||||||
| Address1: | 3195 STILLWATER DR STE A | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863057171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285411740 | ||||||||
| FaxNumber: | 8777751694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 11/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | KLEBERG | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF LEGAL AFFAIRS | ||||||||
| AuthorizedOfficialTelephone: | 7046642876 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | HSPC0060 | AZ | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 408600 | 05 | AZ | MEDICAID | AZ0700420 | 01 | AZ | BC/BS OF ARIZONA | OTHER | IZ0241 | 01 | HEALTH NET | OTHER |