Hospice of Havasu, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

HSPC0011 Issued in AZ

Legal business name

HOSPICE OF HAVASU, INC.

Practice address

232 London Bridge Rd BLDG a
Lake Havasu City, AZ 86403-4647

Phone

(928) 453-2111

NPI assigned

Dec 2, 2005

Last updated

Aug 11, 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. Daniel Mathews

Title

Executive Director

Phone

(928) 453-2111

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649254517. Details of each certification follow.

• CCN 031543 Hospice · Active · Details

Hospice certification: CCN 031543

Legal name

HOSPICE OF HAVASU, INC.

Certification status

Active

Provider type (POS)

Hospice

Participating since

Nov 19, 1997

Last certification

Apr 7, 2021

Ownership / control type

Non-Profit - Other

Organization structure

CorporationNon-profit

Incorporated

Jul 19, 1982 in AZ

Enrollment address

232 London Bridge Rd
BLDG a
Lake Havasu City, AZ 86403-4647

Listed as

Hospice of Havasu, Inc.CCN 031543 · All quality measures

Ownership

Other

Certified

Nov 19, 1997

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

Tax ID family

Hospice of Havasu Inc2 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.

• Hospice of Havasu, Inc.

  • Community Based Hospice Care Agency
  • Big River, CA
  • NPI 1255513578
  NPD tax ID

Locations

All disclosed owners & managing parties 11

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.

• Theron C Tilgner, D.O.

  • Orthopaedic Surgery Physician
  • Lake Havasu City, AZ
  • NPI 1497724413

  W-2 Managing Employee

  CMS ownership

Affiliated clinicians 2

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

• Manu Lonial, M.D.

  • Family Medicine Physician
  • Lake Havasu City, AZ
  • NPI 1063553543

  Hospice

  Care Compare affiliation
• Theron C Tilgner, D.O.

  • Orthopaedic Surgery Physician
  • Lake Havasu City, AZ
  • NPI 1497724413

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628640000000",
    "number": "1649254517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 597",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864050597",
            "telephone_number": "928-453-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 LONDON BRIDGE RD BLDG A",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864034647",
            "telephone_number": "928-453-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF HAVASU, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-02",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A",
        "authorized_official_last_name": "MATHEWS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "928-453-2111",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "AZ",
            "license": "HSPC0011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL ID NUMBER",
            "identifier": "421412",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS ID NUMBER",
            "identifier": "AZ0701560",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Lake Havasu City, AZ
• Providers in Lake Havasu City, 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 Aug 11, 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.