Copper Communities Hospice, LLC
Organization Active NPI Community Based Hospice Care Agency · Gilbert, AZ
NPI 1992030779 · NPPES record last updated May 16, 2022
Key facts
- NPI
- 1992030779
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- HSPC5322 (AZ)
- Legal business name
- COPPER COMMUNITIES HOSPICE, LLC
- Practice address
- 1400 N Gilbert Rd Ste H
Gilbert, AZ 85234-2321 - Phone
- (480) 398-2411
- Fax
- (480) 664-7071
- NPI assigned
- Oct 12, 2009
- Organization subpart
- No
Authorized official
- Name
- Richard E Bass
- Title
- President
- Phone
- (602) 717-4751
Owners & managing parties with NPI records 1
-
Roopesh K Kantala, M.D.
Affiliated clinicians 3
-
Kimberly Dawn Lee, APRN
-
Emily Miller, NP
-
Alejandro Pineda, MD
Medicare Care Compare: Hospice
- Listed as
- Aviant Hospice Phoenix
- Ownership
- For-Profit
- Certified
- Aug 20, 2010
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Hospice certification: CCN 031591
- Legal name
- COPPER COMMUNITIES HOSPICE LLC
- Doing business as
- AVIANT HOSPICE PHOENIX
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Aug 20, 2010
- Last certification
- Jun 8, 2021
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Aug 12, 2009 in AZ
- Enrollment address
- 1400 N Gilbert Rd
Ste H
Gilbert, AZ 85234-2321
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Michael Ea O'Malley |
5% Or Greater Indirect Ownership Interest | Dec 31, 2014 | 25% |
| Corporate Officer |
Jan 1, 2015 | 50% | |
| Richard E Bass |
5% Or Greater Indirect Ownership Interest | Dec 31, 2014 | 25% |
| Corporate Officer |
Jan 1, 2015 | 50% | |
| Aviant Healthcare LLC |
5% Or Greater Direct Ownership Interest | Dec 31, 2014 | 100% |
| Operational/Managerial Control | Dec 31, 2014 | 100% | |
| Leslie Jeanette Cooper Sullivan |
W-2 Managing Employee |
Sep 4, 2018 | 80% |
| Jennifer L Posorske |
5% Or Greater Indirect Ownership Interest |
Dec 18, 2024 | |
| Roopesh Kumar Kantala |
Contracted Managing Employee |
Jul 1, 2024 | |
| Kelli a Rojas |
W-2 Managing Employee |
Aug 5, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100224000006 | AZ | Part a Provider - Hospice | 0749324143 | Practice locations: Gilbert, AZ |
National Provider Directory
Locations
1640 S Stapley Dr
Ste 245
Mesa, AZ 85204
Phone (480) 383-8599
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | HSPC4796 | AZ | |
| Community Based Hospice Care Agency | 251G00000X | HSPC5322 | AZ | Yes |
Addresses
Primary practice location
1400 N Gilbert Rd Ste H
Gilbert, AZ 85234-2321
Mailing address
2430 W Ray Rd Ste 3
Chandler, AZ 85224-3552
Phone (480) 383-8599
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 583314 | Medicaid | AZ |
Other names
- Aviant Hospice Phoenix
Other providers in Gilbert, AZ
- Sondra L Cooper
- Bryan Coots
- Spencer Garrett Copeland
- Casandra Coplan
- Copper Basin Oral Surgery
- Copper Springs Hospital, LLC
- Copper State Dentistry LLC
- Copper Valley Health, LLC
- Elaina Corbin
- George M Corcoran
All providers in Gilbert, AZ · Community Based Hospice Care Agency in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.