Provider Demographics
NPI:1366607145
Name:NORTHLAND HOSPICE & PALLIATIVE CARE
Entity type:Organization
Organization Name:NORTHLAND HOSPICE & PALLIATIVE CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-779-1227
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86002-0997
Mailing Address - Country:US
Mailing Address - Phone:928-779-1227
Mailing Address - Fax:928-779-5884
Practice Address - Street 1:752 N SWITZER CANYON DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4835
Practice Address - Country:US
Practice Address - Phone:928-226-1915
Practice Address - Fax:928-226-1923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHLAND HOSPICE & PALLIATIVE CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-4018177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110495Medicaid
AZ726185Medicaid
AZ031512Medicare Oscar/Certification