Healthcare Provider Details

I. General information

NPI: 1598409450
Provider Name (Legal Business Name): HULLSHAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PARKWOOD DR
ROSE HILL KS
67133-9578
US

IV. Provider business mailing address

401 PARKWOOD DR
ROSE HILL KS
67133-9578
US

V. Phone/Fax

Practice location:
  • Phone: 316-218-3609
  • Fax:
Mailing address:
  • Phone: 316-218-3609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JASON LEE HULL
Title or Position: OWNER
Credential:
Phone: 316-218-3609