Provider Demographics
NPI:1104622950
Name:LAVENDER PALLIATIVE CARE
Entity type:Organization
Organization Name:LAVENDER PALLIATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSELAVENDER
Authorized Official - Middle Name:AGATHA
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-283-3663
Mailing Address - Street 1:2025 N 3RD ST STE 180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1483
Mailing Address - Country:US
Mailing Address - Phone:602-283-3663
Mailing Address - Fax:602-283-3682
Practice Address - Street 1:2025 N 3RD ST STE 180
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1483
Practice Address - Country:US
Practice Address - Phone:602-283-3663
Practice Address - Fax:602-283-3682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care