Sourceone Hospice & Palliative Care, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

SOURCEONE HOSPICE & PALLIATIVE CARE, LLC

Practice address

14362 N Frank Lloyd Wright Blvd Ste 2154
Scottsdale, AZ 85260-8846

Phone

(310) 357-0398

NPI assigned

Sep 23, 2022

Organization subpart

No

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

Authorized official

Name

Shellydale Princess Gray

Title

Owner/Administrator

Phone

(310) 357-0398

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• SourceOne Hospice & Palliative Care, LLC Doing business as

Locations

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

{
    "created_epoch": "1663891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663891200000",
    "number": "1942923958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14362 N FRANK LLOYD WRIGHT BLVD STE 2154",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852608846",
            "telephone_number": "310-357-0398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14362 N FRANK LLOYD WRIGHT BLVD STE 2154",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852608846",
            "telephone_number": "310-357-0398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCEONE HOSPICE & PALLIATIVE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-23",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "SHELLYDALE",
        "authorized_official_middle_name": "PRINCESS",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "310-357-0398"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPICE (08)",
            "identifier": "1093334880",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SourceOne Hospice & Palliative Care, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.