Charles WM. Leighton Jr Hospice, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

HSPC-2902 Issued in AZ

Legal business name

CHARLES WM. LEIGHTON JR HOSPICE, INC.

Practice address

524 West Maley Place
Willcox, AZ 85643

Phone

(520) 384-5878

Fax

(520) 384-4127

NPI assigned

Jul 7, 2005

Last updated

Dec 28, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Gordon D Douglas

Title

Administrator

Phone

(520) 384-5878

Specialties & licenses 1

Addresses

Other names 1

• Charles Wm. Leighton Hospice, Inc. Other name

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366440083. Details of each certification follow.

• CCN 031551 Hospice · Active · Details

Hospice certification: CCN 031551

Legal name

CHARLES WM LEIGHTON JR HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 2, 2001

Last certification

Feb 26, 2021

Ownership / control type

Proprietary - Individual

Organization structure

CorporationNon-profit

Incorporated

Nov 13, 1996 in AZ

Enrollment address

524W Maley PL
Willcox, AZ 85643-2042

Listed as

Charles WM. Leighton, Jr. Hospice, Inc.CCN 031551 · All quality measures

Ownership

Other

Certified

Aug 2, 2001

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 6

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

Owners & managing parties with NPI records 1

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

• Troy Lee Garey, DMD

  • General Practice Dentistry
  • Reserve, NM
  • NPI 1982787495

  Corporate Director

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kerri Hendricks, RN

  • Registered Nurse
  • Safford, AZ
  • NPI 1972927770
  NPD

Affiliated clinicians 3

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

• Trevor Alan Jones, FNP-C

  • Family Nurse Practitioner
  • Tucson, AZ
  • NPI 1316482789

  Hospice

  Care Compare affiliation
• Monica R Vandivort, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Sierra Vista, AZ
  • NPI 1720044365

  Hospice

  Care Compare affiliation
• Jordan Aaron Fisher, MD

  • Internal Medicine Physician
  • Dothan, AL
  • NPI 1477013126

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1366440083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 115",
            "city": "WILLCOX",
            "state": "AZ",
            "postal_code": "85644",
            "telephone_number": "520-384-5878",
            "fax_number": "520-384-4127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 WEST MALEY PLACE",
            "city": "WILLCOX",
            "state": "AZ",
            "postal_code": "85643",
            "telephone_number": "520-384-5878",
            "fax_number": "520-384-4127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES WM. LEIGHTON JR HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "520-384-5878",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "AZ",
            "license": "HSPC-2902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charles Wm. Leighton Hospice, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Amanda Dawn Bennett, FNP-C
• Dale Todd Bennett, M.ED
• Nickalaus David Bryce, PHARMD
• Jeffery Burl Bushman, D.O.
• Abby F Camisa, OTD
• Child & Family Resources, Inc.
• Chiricahua Community Health Centers, Inc. (Willcox Clinic)
• Amanda Ann Davis, NP
• Sunny Lynn De Baun
• Angela Diaz, LMT

• Community Based Hospice Care Agency in Willcox, AZ
• Providers in Willcox, AZ by specialty
• Community Based Hospice Care Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.