Healthcare Provider Details

I. General information

NPI: 1134123011
Provider Name (Legal Business Name): HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 PENNSYLVANIA AVE
OTTUMWA IA
52501-2138
US

IV. Provider business mailing address

PO BOX 1150
OTTUMWA IA
52501-7150
US

V. Phone/Fax

Practice location:
  • Phone: 641-682-0684
  • Fax: 641-684-9209
Mailing address:
  • Phone: 641-682-0684
  • Fax: 641-684-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE M ANDERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 641-682-0684