NPIMap

Organization Active NPI

Copper Basin Healthcare, Inc.

Doing business as The Pines Hospice

  • Community Based Hospice Care Agency
  • Prescott Valley, AZ
National Provider Identifier
1245778323
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
COPPER BASIN HEALTHCARE, INC.
Doing business as
The Pines Hospice
Practice address
6719 E 2ND St Ste a
Prescott Valley, AZ 86314-2661
Phone
(928) 632-0111
Fax
(928) 632-0333
NPI assigned
Feb 8, 2017
Last updated
Jan 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Authorized official

Name
Amber L Tueller
Title
Secretary
Phone
(208) 207-2726

Specialties & licenses 1

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

Addresses

Primary practice location

6719 E 2ND St Ste a
Prescott Valley, AZ 86314-2661

Mailing address

6719 E 2ND St Ste a
Prescott Valley, AZ 86314-2661
Phone (928) 632-0111

Other names 1

  • The Pines Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170322002087 AZ Part A Provider - Hospice 3173808789 Practice locations: Prescott, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245778323. Details of each certification follow.

Hospice certification: CCN 031559

Legal name
COPPER BASIN HEALTHCARE, INC.
Doing business as
THE PINES HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 16, 2005
Last certification
Jun 24, 2022
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Enrollment address
804 Ainsworth Dr
Ste 102a
Prescott, AZ 86301-1624

Care Compare: Hospice

Medicare Care Compare
Listed as
The Pines HospiceCCN 031559 · All quality measures
Ownership
For-Profit
Certified
Jun 16, 2005
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2132161Pines Hospice, the804 Ainsworth Dr Ste 102a, Prescott, AZ 86301Certificate of waiverJun 12, 2027

National Provider Directory

National Provider Directory

Locations

13175 E State Route 169
Ste B
Dewey, AZ 86327
Phone (928) 632-0111

13207 E State Route 169
Ste A
Dewey, AZ 86327
Phone (928) 632-0111

804 Ainsworth Dr
Ste 102A
Prescott, AZ 86301
Phone (928) 632-0111

6719 E 2nd St
Ste A
Prescott Valley, AZ 86314
Phone (928) 632-0111

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
Cornerstone Healthcare Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Direct Ownership Interest Mar 1, 2017 100%
Brent Mills Individual Corporate OfficerTreasurer Mar 25, 2026
Brent Guerisoli Individual Corporate DirectorDirector/Sole Board Member Jan 30, 2019
Richard W Moos Individual Contracted Managing EmployeeMD; Feb 1, 2025
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2019 100%
Jason Huizinga Individual W-2 Managing EmployeeAd; Dec 30, 2025
John J Gochnour Individual Corporate OfficerPresident Jan 24, 2024
Amber Tueller Individual Corporate OfficerSecretary Jan 4, 2025

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 141

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

View all 141

Change-of-ownership history 1

DateEventCounterparty
Mar 1, 2017 Change of OwnershipThis provider was the buyer Hospice of the PinesCCN 031559, AZ, NPI 1134243157

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": "1486512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736985600000",
    "number": "1245778323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6719 E 2ND ST STE A",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142661",
            "telephone_number": "928-632-0111",
            "fax_number": "928-632-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6719 E 2ND ST STE A",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142661",
            "telephone_number": "928-632-0111",
            "fax_number": "928-632-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPPER BASIN HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-08",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pines Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott Valley, AZ

Sources for this page

Verify at the official NPI Registry.