NPIMap

Organization Active NPI

Canyon Arizona Home Care & Hospice LLC

Doing business as Canyon Home Care & Hospice

  • Community Based Hospice Care Agency
  • Phoenix, AZ
National Provider Identifier
1306485313
Registry record updated Oct 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
CANYON ARIZONA HOME CARE & HOSPICE LLC
Doing business as
Canyon Home Care & Hospice
Practice address
7878 N 16TH St Ste 155
Phoenix, AZ 85020-4449
Phone
(602) 314-6246
Fax
(602) 314-6252
NPI assigned
Dec 23, 2019
Last updated
Oct 26, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2021

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

Authorized official

Name
Kenneth E Norris
Title
Managing Partner
Phone
(801) 485-6166

Specialties & licenses 1

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

Addresses

Primary practice location

7878 N 16TH St Ste 155
Phoenix, AZ 85020-4449

Mailing address

450 S 900 E Ste 100
Salt Lake City, UT 84102-2983
Phone (801) 485-6166

Other practice location 1

1760 E Pecos Rd Ste 247
Gilbert, AZ 85295-3214
Phone (480) 597-3661

Other practice location 2

10150 W Desert River Blvd Ste A-110B
Glendale, AZ 85307-3008
Phone (602) 216-2273

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
O20200201000078 AZ Part A Provider - Hospice 2668706565 Practice locations: Glendale, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306485313. Details of each certification follow.

Hospice certification: CCN 031711

Legal name
CANYON ARIZONA HOME CARE & HOSPICE LLC
Doing business as
CANYON HOME CARE & HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 16, 2020
Last certification
Apr 16, 2020
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
Dec 26, 2017 in AZ
Enrollment address
10150 W Desert River Blvd
Ste a-150
Glendale, AZ 85307-3008

Care Compare: Hospice

Medicare Care Compare
Listed as
Canyon Home Care & HospiceCCN 031711 · All quality measures
Ownership
For-Profit
Certified
Apr 16, 2020
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Canyon Arizona Home Care Hospice LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Locations

1760 E Pecos Rd
Ste 247
Gilbert, AZ 85295
Phone (480) 597-3661

1760 E Pecos Rd
Ste 247A
Gilbert, AZ 85295
Phone (480) 597-3661

10150 W Desert River Blvd
Ste A110B
Glendale, AZ 85307
Phone (602) 216-2273

10150 W Desert River Blvd
Ste A150
Glendale, AZ 85307
Phone (602) 216-2273

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
Natacha Vanhorn Individual W-2 Managing EmployeeAd; Aug 1, 2025
Orange Healthcare, LLC Organization, Holladay, UT LLC 5% Or Greater Indirect Ownership Interest Jan 10, 2020 50%
Thomas G Dallman Individual W-2 Managing EmployeeMD; Aug 1, 2025
Kenneth Edwin Norris Individual 5% Or Greater Indirect Ownership InterestManaging Partner Jan 10, 2020 50%
Corporate OfficerManaging Partner Jan 10, 2020 100%
Operational/Managerial ControlManaging Partner Jan 10, 2020 100%
Tyson Cichos Individual 5% Or Greater Indirect Ownership Interest Jan 10, 2020 25%
Cory R Robison Individual 5% Or Greater Indirect Ownership Interest Jan 10, 2020 25%
Home Caregivers Partnership, LLC Organization, Salt Lake City, UT LLC 5% Or Greater Direct Ownership Interest Jan 10, 2020 100%
Terri Brevard Individual W-2 Managing EmployeeClinical Manager Aug 1, 2025 100%

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Canyon Home Care & HospiceGilbert, AZ, CCN 037418 Home health agency 5% Or Greater Direct Ownership Interest (100%) May 1, 2019
Canyon Home Care & HospiceBullhead City, AZ, CCN 031781 Hospice 5% Or Greater Direct Ownership Interest (100%) Nov 4, 2022

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 6

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": "1577059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635206400000",
    "number": "1306485313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 S 900 E STE 100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841022983",
            "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": "7878 N 16TH ST STE 155",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850204449",
            "telephone_number": "602-314-6246",
            "fax_number": "602-314-6252"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1760 E Pecos Rd Ste 247",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852953214",
            "country_code": "US",
            "telephone_number": "480-597-3661",
            "fax_number": "480-597-3660",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10150 W Desert River Blvd Ste A-110B",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853073008",
            "country_code": "US",
            "telephone_number": "602-216-2273",
            "fax_number": "602-443-5398",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CANYON ARIZONA HOME CARE & HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-23",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A",
        "authorized_official_last_name": "NORRIS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "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"
        },
        {
            "organization_name": "Canyon Home Care & Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.