Organization
BLUE MOON HOSPICE CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA SHYSHAKOVA (CEO)
(928) 766-0902
Entity
Organization
Contact information
Practice address
13041 N 35TH AVE STE C11-12, PHOENIX, AZ 85029-1230
(928) 766-0902
(928) 766-4123
Mailing address
13041 N 35TH AVE STE C11-12, PHOENIX, AZ 85029-1230
(928) 766-0902
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
—
—
Other
Enumeration date
03/31/2022
Last updated
03/31/2022
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