Healthcare Provider Details

I. General information

NPI: 1326045055
Provider Name (Legal Business Name): HOSPICE WITH HEART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E GRAHAM AVE SUITE 2
COUNCIL BLUFFS IA
51503-6691
US

IV. Provider business mailing address

101 E GRAHAM AVE SUITE 2
COUNCIL BLUFFS IA
51503-6691
US

V. Phone/Fax

Practice location:
  • Phone: 712-325-6802
  • Fax: 712-322-2671
Mailing address:
  • Phone: 712-325-6802
  • Fax: 712-322-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. DAWN RENEE STANE
Title or Position: DIRECTOR OF OPERATIONS
Credential: RN
Phone: 712-325-6802