Healthcare Provider Details

I. General information

NPI: 1780609396
Provider Name (Legal Business Name): SOUTH WIND HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 YUCCA LANE
PRATT KS
67124-0000
US

IV. Provider business mailing address

496 YUCCA LANE
PRATT KS
67124-0000
US

V. Phone/Fax

Practice location:
  • Phone: 620-672-7553
  • Fax: 620-672-7554
Mailing address:
  • Phone: 620-672-7553
  • Fax: 620-672-7554

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 StateKS

VIII. Authorized Official

Name: MRS. GINGER C GOERING
Title or Position: EXECUTIVE DIRECTOR
Credential: LBSW KS#4904
Phone: 620-672-7553