MEDICARE: HOSPICE WITH HEART

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

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
2	61574	OTHER	IA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1326045055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE WITH HEART

Provider Business Mailing Address
First Line	:	101 E GRAHAM AVE
Second Line	:	SUITE 2
City	:	COUNCIL BLUFFS
State	:	IA
Zip	:	51503-6691
Country	:	US
Telephone Number	:	712-325-6802
Fax Number	:	712-322-2671

Provider Business Practice Location Address
First Line	:	101 E GRAHAM AVE
Second Line	:	SUITE 2
City	:	COUNCIL BLUFFS
State	:	IA
Zip	:	51503-6691
Country	:	US
Telephone Number	:	712-325-6802
Fax Number	:	712-322-2671

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MRS. DAWN RENEE STANE
Credential	:	RN
Telephone Number	:	712-325-6802

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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Directions to “HOSPICE WITH HEART ” Practice Location

Language	Start Address	Practice Location

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