Healthcare Provider Details

I. General information

NPI: 1043411861
Provider Name (Legal Business Name): XL HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 HIGHWAY 52
PAYETTE ID
83661-5536
US

IV. Provider business mailing address

57 GROVE RD
ONTARIO OR
97914-8155
US

V. Phone/Fax

Practice location:
  • Phone: 208-642-9222
  • Fax: 208-642-9224
Mailing address:
  • Phone: 208-262-3443
  • Fax: 208-642-9224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW1449
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW707
License Number StateID

VIII. Authorized Official

Name: MR. DWIGHT ERWIN OLSON
Title or Position: OWNER
Credential: LCSW
Phone: 208-642-9222