Organization
HOSPICE OF HAVASU, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL MATHEWS (EXECUTIVE DIRECTOR)
(928) 453-2111
Entity
Organization
Contact information
Practice address
232 LONDON BRIDGE RD BLDG A, LAKE HAVASU CITY, AZ 86403-4647
(928) 453-2111
Mailing address
PO BOX 597, LAKE HAVASU CITY, AZ 86405-0597
(928) 453-2111
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
HSPC0011
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
421412
FEDERAL ID NUMBER
AZ
01
—
AZ0701560
BC/BS ID NUMBER
AZ
Enumeration date
12/02/2005
Last updated
08/11/2021
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