NPIMap

Organization Active NPI

St Theresa Hospice LLC

Doing business as Canyon Home Care & Hospice

  • Community Based Hospice Care Agency
  • Bullhead City, AZ
National Provider Identifier
1104389535
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
ST THERESA HOSPICE LLC
Doing business as
Canyon Home Care & Hospice
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
Last updated
Aug 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Breezie Liskey
Title
VP of Operations
Phone
(801) 485-6166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

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 1

  • Canyon Home Care & Hospice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210805000141 AZ Part A Provider - Hospice 6406250976 Practice locations: Bullhead City, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104389535. Details of each certification follow.

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
LLCProprietary
Incorporated
Mar 27, 2019 in AZ
Enrollment address
3003 Highway 95
Ste 21
Bullhead City, AZ 86442-7896

Care Compare: Hospice

Medicare Care Compare
Listed as
Canyon HospiceCCN 031781 · All quality measures
Ownership
For-Profit
Certified
Nov 20, 2003
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2031 Highway 95
Bullhead City, AZ 86442
Phone (480) 597-3661

2031 Highway 95
Ste 1
Bullhead City, AZ 86442

3003 Highway 95
Ste 21
Bullhead City, AZ 86442
Phone (928) 605-4009

3003 Highway 95
Ste C21
Bullhead City, AZ 86442

519 E Eva St
Ste B
Phoenix, AZ 85020
Phone (602) 567-0233

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Canyon Advisory Group LLC Organization, Salt Lake City, UT LLC 5% Or Greater Indirect Ownership Interest Nov 4, 2022 50%
Natacha Vanhorn Individual W-2 Managing EmployeeAd; May 19, 2025
Orange Healthcare, LLC Organization, Holladay, UT LLC 5% Or Greater Indirect Ownership Interest Nov 4, 2022 50%
Thomas G Dallman Individual Contracted Managing EmployeeMD; May 9, 2025
Canyon Arizona Home Care & Hospice LLC Organization, Salt Lake City, UT LLC 5% Or Greater Direct Ownership Interest Nov 4, 2022 100%
Kenneth Edwin Norris Individual 5% Or Greater Indirect Ownership Interest Nov 4, 2022 50%
Corporate OfficerManaging Member Nov 4, 2022 100%
Operational/Managerial ControlManaging Member Nov 4, 2022 100%
Tyson Cichos Individual 5% Or Greater Indirect Ownership Interest Nov 4, 2022 25%
Cory R Robison Individual 5% Or Greater Indirect Ownership Interest Nov 4, 2022 25%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754956800000",
    "number": "1104389535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "746 E WINCHESTER ST STE 200",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841078513",
            "telephone_number": "801-485-6166",
            "fax_number": "801-531-1949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 HIGHWAY 95 STE 21",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864427896",
            "telephone_number": "928-605-4009",
            "fax_number": "928-940-2057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST THERESA HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-11",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A",
        "authorized_official_last_name": "LISKEY",
        "authorized_official_first_name": "BREEZIE",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "801-485-6166"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Home Care & Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bullhead City, AZ

Sources for this page

Verify at the official NPI Registry.