Healthcare Provider Details

I. General information

NPI: 1366200511
Provider Name (Legal Business Name): SOLACE HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 COMMERCIAL ST
ROANOKE IN
46783-1045
US

IV. Provider business mailing address

PO BOX 490
ROANOKE IN
46783-0490
US

V. Phone/Fax

Practice location:
  • Phone: 260-600-9912
  • Fax:
Mailing address:
  • Phone: 260-452-9261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BUNN
Title or Position: PRESIDENT/ADMINISTRATOR
Credential: MBA, MSN, RN, CHPN
Phone: 260-452-9261