Provider Demographics
NPI:1053980623
Name:CAMELBACK HOSPICE LLC
Entity type:Organization
Organization Name:CAMELBACK HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGED
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:ARMEN
Authorized Official - Last Name:ABRAMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-892-4783
Mailing Address - Street 1:11811 N TATUM BLVD STE 3031-52
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1614
Mailing Address - Country:US
Mailing Address - Phone:602-892-4783
Mailing Address - Fax:602-649-0711
Practice Address - Street 1:11811 N TATUM BLVD STE 3031-52
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1614
Practice Address - Country:US
Practice Address - Phone:602-892-4783
Practice Address - Fax:602-649-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based