Healthcare Provider Details

I. General information

NPI: 1396746103
Provider Name (Legal Business Name): BIG BEND HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 MAHAN CENTER BLVD
TALLAHASSEE FL
32308-5428
US

IV. Provider business mailing address

1723 MAHAN CENTER BLVD
TALLAHASSEE FL
32308-5428
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-5310
  • Fax: 850-309-1638
Mailing address:
  • Phone: 850-878-5310
  • Fax: 850-309-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number5002096
License Number StateFL

VIII. Authorized Official

Name: WILLIAM E WERTMAN
Title or Position: CEO/ADMINISTRATOR
Credential: MSW
Phone: 850-878-5310