Healthcare Provider Details

I. General information

NPI: 1952308751
Provider Name (Legal Business Name): XL HOSPICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 HIGHWAY 52
PAYETTE ID
83661-5536
US

IV. Provider business mailing address

2480 HIGHWAY 52
PAYETTE ID
83661-5536
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0699275-7
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0001449710
License Number StateID

VIII. Authorized Official

Name: BARBARA B OLSON
Title or Position: OWNER
Credential:
Phone: 208-642-9222