NPIMap

Organization Active NPI

Primavera Hospice LLC

  • Community Based Hospice Care Agency
  • Glendale, AZ
National Provider Identifier
1689322307
Registry record updated Mar 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
PRIMAVERA HOSPICE LLC
Practice address
8751 N. 51St Avenue Ste 121-E
Glendale, AZ 85302
Phone
(480) 343-8045
NPI assigned
Mar 11, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2022

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

Authorized official

Name
Teresita P Isiderio
Title
Administrator
Phone
(480) 343-8045

Specialties & licenses 1

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

Addresses

Primary practice location

8751 N. 51St Avenue Ste 121-E
Glendale, AZ 85302

Mailing address

8751 N. 51St Avenue Ste 121-E
Glendale, AZ 85302
Phone (480) 343-8045

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220928001000 AZ Part A Provider - Hospice 5395121362 Practice locations: Glendale, AZ

Hospice certification: CCN 001534

Legal name
PRIMAVERA HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 21, 2022
Last certification
Oct 21, 2022
Organization structure
LLCProprietary
Incorporated
Jul 21, 2021 in AZ
Enrollment address
8751 N 51St Ave
Ste 121E
Glendale, AZ 85302-4900

Care Compare: Hospice

Medicare Care Compare
Listed as
Primavera Hospice LLCCCN 001534
Certified
Oct 21, 2022
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

8751 N 51st Ave
Ste 121E
Glendale, AZ 85302
Phone (480) 343-8045

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Ma Teresita Patino Isiderio Individual W-2 Managing EmployeeAdministrator Jul 21, 2021 5%
Lyndon Avelino Individual 5% Or Greater Direct Ownership InterestCfo Jul 21, 2021 40%
Pamela Patino Avelino Individual 5% Or Greater Direct Ownership InterestCeo Jul 21, 2021 60%

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 2

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": "1646956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646956800000",
    "number": "1689322307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8751 N. 51ST AVENUE STE 121-E",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85302",
            "telephone_number": "480-343-8045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8751 N. 51ST AVENUE STE 121-E",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85302",
            "telephone_number": "480-343-8045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMAVERA HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-11",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A",
        "authorized_official_last_name": "ISIDERIO",
        "authorized_official_first_name": "TERESITA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "480-343-8045"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.