Healthcare Provider Details

I. General information

NPI: 1801890892
Provider Name (Legal Business Name): HOSPICE OF DUBUQUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 JOHN F KENNEDY RD
DUBUQUE IA
52002-5106
US

IV. Provider business mailing address

1670 JOHN F KENNEDY RD
DUBUQUE IA
52002-5106
US

V. Phone/Fax

Practice location:
  • Phone: 563-582-1220
  • Fax: 563-582-8089
Mailing address:
  • Phone: 563-582-1220
  • Fax: 563-582-8089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number2001618
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number562
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateIA

VIII. Authorized Official

Name: LAVONNE NOEL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 563-582-1220