MEDICARE: COMPASSIONATE CARE HOSPICE OF THE MIDWEST, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency		SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215930847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE CARE HOSPICE OF THE MIDWEST, LLC

Provider Business Mailing Address
First Line	:	3854 AMERICAN WAY STE A
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4897
Country	:	US
Telephone Number	:	225-292-2031
Fax Number	:	225-295-9678

Provider Business Practice Location Address
First Line	:	3415 N POTSDAM AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-7017
Country	:	US
Telephone Number	:	605-338-2066
Fax Number	:	605-371-3754

Authorized Official
Title or Position	:	DELEGATED OFFICIAL
Name	:	PATRICIA U. GOFF
Credential	:
Telephone Number	:	225-299-3701

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	10/02/2019

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