St Theresa Hospice LLC
Organization Active NPI Community Based Hospice Care Agency · Bullhead City, AZ
NPI 1104389535 · NPPES record last updated Aug 12, 2025
Key facts
- NPI
- 1104389535
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- ST THERESA HOSPICE LLC
- Practice address
- 3003 Highway 95 Ste 21
Bullhead City, AZ 86442-7896 - Phone
- (928) 605-4009
- Fax
- (928) 940-2057
- NPI assigned
- Apr 11, 2019
- Organization subpart
- No
Authorized official
- Name
- Breezie Liskey
- Title
- VP of Operations
- Phone
- (801) 485-6166
Owners & managing parties with NPI records 1
Member of 1
Facilities with the same owner 9
Affiliated clinicians 1
-
Scott Edward Ewing, FNP-BC
Medicare Care Compare: Hospice
- Listed as
- Canyon Hospice
- Ownership
- For-Profit
- Certified
- Nov 20, 2003
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Hospice certification: CCN 031781
- Legal name
- ST THERESA HOSPICE, LLC
- Doing business as
- CANYON HOME CARE & HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Nov 20, 2003
- Last certification
- Mar 11, 2022
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Mar 27, 2019 in AZ
- Enrollment address
- 3003 Highway 95
Ste 21
Bullhead City, AZ 86442-7896
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Canyon Advisory Group LLC |
5% Or Greater Indirect Ownership Interest | Nov 4, 2022 | 50% |
| Natacha Vanhorn |
W-2 Managing Employee |
May 19, 2025 | |
| Orange Healthcare, LLC |
5% Or Greater Indirect Ownership Interest | Nov 4, 2022 | 50% |
| Thomas G Dallman |
Contracted Managing Employee |
May 9, 2025 | |
| Canyon Arizona Home Care & Hospice LLC |
5% Or Greater Direct Ownership Interest | Nov 4, 2022 | 100% |
| Kenneth Edwin Norris |
5% Or Greater Indirect Ownership Interest | Nov 4, 2022 | 50% |
| Corporate Officer |
Nov 4, 2022 | 100% | |
| Operational/Managerial Control |
Nov 4, 2022 | 100% | |
| Tyson Cichos |
5% Or Greater Indirect Ownership Interest | Nov 4, 2022 | 25% |
| Cory R Robison |
5% Or Greater Indirect Ownership Interest | Nov 4, 2022 | 25% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210805000141 | AZ | Part a Provider - Hospice | 6406250976 | Practice locations: Bullhead City, AZ |
National Provider Directory
Locations
3003 Highway 95
Ste 21
Bullhead City, AZ 86442
Phone (928) 605-4009
2031 Highway 95
Ste 1
Bullhead City, AZ 86442
3003 Highway 95
Ste C21
Bullhead City, AZ 86442
2031 Highway 95
Bullhead City, AZ 86442
Phone (480) 597-3661
519 E Eva St
Ste B
Phoenix, AZ 85020
Phone (602) 567-0233
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
3003 Highway 95 Ste 21
Bullhead City, AZ 86442-7896
Mailing address
746 E Winchester St Ste 200
Murray, UT 84107-8513
Phone (801) 485-6166
Other names
- Canyon Home Care & Hospice
Other providers in Bullhead City, AZ
- Southwest Behavioral Health Services, Inc.
- Southwest Behavioral Health Services,Inc.
- Southwest Cardiovascular Associates Ahmed Alfafara and Prasad LTD
- Southwest Orthopedic Services LLC
- Southwestern Eye Center LTD
- Nathan Jon Stackhouse
- Nicholas Scott Stagg
- Jennifer Staggs
- Blake A Stamper
- Lisa A Stanley
All providers in Bullhead City, AZ · Community Based Hospice Care Agency in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2025. 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.