NPIMap

Organization Active NPI

Whitetank Mountain Healthcare LLC

Doing business as Emblem Hospice West

  • Community Based Hospice Care Agency
  • Phoenix, AZ
National Provider Identifier
1912665571
Registry record updated May 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
WHITETANK MOUNTAIN HEALTHCARE LLC
Doing business as
Emblem Hospice West
Practice address
301 E Bethany Home Rd Ste C292
Phoenix, AZ 85012-1271
Phone
(623) 322-8686
NPI assigned
Dec 1, 2021
Last updated
May 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2025

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

301 E Bethany Home Rd Ste C292
Phoenix, AZ 85012-1271

Mailing address

301 E Bethany Home Rd Ste C292
Phoenix, AZ 85012-1271
Phone (623) 322-8686

Other names 1

  • Emblem Hospice West Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230130001089 AZ Part A Provider - Hospice 1052782083 Practice locations: Phoenix, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912665571. Details of each certification follow.

Hospice certification: CCN 031661

Legal name
WHITETANK MOUNTAIN HEALTHCARE LLC
Doing business as
EMBLEM HOSPICE WEST
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 3, 2017
Last certification
May 17, 2019
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Enrollment address
301 E Bethany Home Rd
Ste C292
Phoenix, AZ 85012-1271

Care Compare: Hospice

Medicare Care Compare
Listed as
Emblem Hospice WestCCN 031661 · All quality measures
Ownership
For-Profit
Certified
Jun 3, 2017
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
03D2119688Whitetank Mountain Healthcare LLC301 E Bethany Home Rd Ste C292, Phoenix, AZ 85012Certificate of waiverOct 2, 2026

National Provider Directory

National Provider Directory

Locations

10320 W McDowell Rd
Bldg G
Avondale, AZ 85392
Phone (480) 571-5541

10320 W McDowell Rd
Ste 7024
Avondale, AZ 85392
Phone (623) 322-8686

301 E Bethany Home Rd
Ste C292
Phoenix, AZ 85012
Phone (623) 322-8686

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Morgan Garcia Individual W-2 Managing EmployeeAdministrator Jan 1, 2023
Cornerstone Healthcare Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Direct Ownership Interest Oct 14, 2021 100%
Brent Mills Individual Corporate OfficerTreasurer Mar 26, 2026
Brent Guerisoli Individual Corporate OfficerDirector/Sole Board Member Oct 14, 2021
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Oct 14, 2021 100%
Vinee Srivastava Individual Contracted Managing EmployeeMD; Sep 5, 2023
John J Gochnour Individual Corporate OfficerPresident/Manager Aug 28, 2024
Amber Tueller Individual Corporate OfficerSecretary Aug 24, 2024
Elliot McMillan Individual Corporate OfficerSecretary Oct 14, 2021

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
Jan 1, 2023 Change of OwnershipThis provider was the buyer Emblem Hospice WestCCN 031661, AZ, NPI 1164054136

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

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": "1638316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747699200000",
    "number": "1912665571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 E BETHANY HOME RD STE C292",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121271",
            "telephone_number": "623-322-8686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E BETHANY HOME RD STE C292",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121271",
            "telephone_number": "623-322-8686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITETANK MOUNTAIN HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-01",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emblem Hospice West",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Emblem Hospice West",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.