A Peaceful Journey Hospice, LLC
Organization Active NPI Community Based Hospice Care Agency · Aurora, CO
NPI 1003483330 · NPPES record last updated Jun 14, 2024
Key facts
- NPI
- 1003483330
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- A PEACEFUL JOURNEY HOSPICE, LLC
- Practice address
- 2851 S Parker Rd Ste 1130
Aurora, CO 80014-2732 - Phone
- (303) 755-0915
- NPI assigned
- Jun 7, 2021
- Organization subpart
- No
Authorized official
- Name
- Sandra Brown, RN
- Title
- Ceo/ Administrator
- Phone
- (480) 358-7633
Practitioners 1
-
Sandra Brown, RN
Affiliated clinicians 5
-
Hong Chang, NP
-
Emily Clare Kubovic, FNP-C
-
Kyle William Mueller, DNP, APRN, A-GNP-C
Medicare Care Compare: Hospice
- Listed as
- A Peaceful Journey Hospice
- Certified
- Sep 28, 2022
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D2229676 | A Peaceful Journey Hospice, LLC | Certificate of waiver | Jul 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Hospice certification: CCN 061622
- Legal name
- A PEACEFUL JOURNEY HOSPICE, LLC
- Doing business as
- A PEACEFUL JOURNEY HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Sep 28, 2022
- Last certification
- Sep 21, 2022
- Ownership / control type
- Proprietary - Other
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 16, 2021 in CO
- Enrollment address
- 2851 S Parker Rd
Ste 1130
Aurora, CO 80014-2732
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Sandra Brown |
5% Or Greater Direct Ownership Interest | Nov 1, 2023 | 17.5% |
| W-2 Managing Employee |
Jun 1, 2021 | ||
| David Brown |
5% Or Greater Direct Ownership Interest | Nov 1, 2023 | 17.5% |
| Corporate Director | May 2, 2021 | ||
| Mark Hackett |
5% Or Greater Direct Ownership Interest | Nov 1, 2023 | 30% |
| Corporate Director | May 1, 2021 | ||
| Donna J Sorenson |
5% Or Greater Direct Ownership Interest |
Nov 1, 2023 | 17.5% |
| Corporate Director | May 1, 2021 | ||
| W-2 Managing Employee | Nov 1, 2023 | ||
| Jon R Sorensen |
5% Or Greater Direct Ownership Interest | Nov 1, 2023 | 17.5% |
| Corporate Director | May 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210726000535 | CO | Part a Provider - Hospice | 6204239544 | Practice locations: Aurora, CO |
National Provider Directory
Locations
2851 S Parker Rd
Ste 1130
Aurora, CO 80014
Phone (303) 755-0915
2821 S Parker Rd
Ste 135
Aurora, CO 80014
Phone (303) 755-0915
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
2851 S Parker Rd Ste 1130
Aurora, CO 80014-2732
Mailing address
2851 S Parker Rd Ste 1130
Aurora, CO 80014-2732
Phone (303) 755-0915
Other names
- A Peaceful Journey Hospice
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.