Provider Demographics
NPI:1275027526
Name:SOLARIS HOSPICE AZ, INC.
Entity type:Organization
Organization Name:SOLARIS HOSPICE AZ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-627-1011
Mailing Address - Street 1:2250 S FM 51 STE 400
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3767
Mailing Address - Country:US
Mailing Address - Phone:940-627-1011
Mailing Address - Fax:
Practice Address - Street 1:1060 IRON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1622
Practice Address - Country:US
Practice Address - Phone:940-627-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZHSPC9110OtherSTATE LICENSURE