Provider Demographics
NPI:1053609727
Name:SEASONS HOSPICE & PALLIATIVE CARE OF ARIZONA, LLC
Entity type:Organization
Organization Name:SEASONS HOSPICE & PALLIATIVE CARE OF ARIZONA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP LEGAL
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SISCEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-221-0465
Mailing Address - Street 1:6400 SHAFER CT
Mailing Address - Street 2:STE 700
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4914
Mailing Address - Country:US
Mailing Address - Phone:847-692-1000
Mailing Address - Fax:
Practice Address - Street 1:7720 N 16TH ST STE 400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-7405
Practice Address - Country:US
Practice Address - Phone:480-606-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ689505Medicaid
AZ031603Medicare Oscar/Certification