03D2110927 CLIA NUMBER - LHCG LXXVII, LLC DBA NORTHERN ARIZONA HOSPICE

Laboratory Demographics

CLIA Number: 03D2110927

Facility Name: LHCG LXXVII, LLC DBA NORTHERN ARIZONA HOSPICE

Facility Address:
203 S CANDY LANE, STE 2A
COTTONWOOD, AZ
ZIP 86326
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Facility Phone Number: (928) 639-6676

Facility Type: HOSPICE

Certificate Type: Waiver

NPI Number: 1164882619

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

Field Name	Field Value
CLIA Number	03D2110927
LAB Type	HOSPICE
Facility Name	LHCG LXXVII, LLC DBA NORTHERN ARIZONA HOSPICE
Street	203 S CANDY LANE, STE 2A
City	COTTONWOOD
State	AZ
ZIP	86326
Phone	(928) 639-6676

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Laboratory Demographics

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