Organization
SOURCEONE HOSPICE & PALLIATIVE CARE, LLC
Active
Other names
SourceOne Hospice & Palliative Care, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLYDALE PRINCESS GRAY (OWNER/ADMINISTRATOR)
(310) 357-0398
Entity
Organization
Contact information
Practice address
14362 N FRANK LLOYD WRIGHT BLVD STE 2154, SCOTTSDALE, AZ 85260-8846
(310) 357-0398
Mailing address
14362 N FRANK LLOYD WRIGHT BLVD STE 2154, SCOTTSDALE, AZ 85260-8846
(310) 357-0398
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093334880
HOSPICE (08)
AZ
Enumeration date
09/23/2022
Last updated
09/23/2022
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