Healthcare Provider Details

I. General information

NPI: 1962768689
Provider Name (Legal Business Name): HOSPICE PREFERRED CHOICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 AMERICAN BLVD W SUITE 655
BLOOMINGTON MN
55437-1108
US

IV. Provider business mailing address

5001 AMERICAN BLVD W SUITE 655
BLOOMINGTON MN
55437-1108
US

V. Phone/Fax

Practice location:
  • Phone: 952-943-0009
  • Fax:
Mailing address:
  • Phone: 952-943-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2086H0002X
TaxonomyHospice and Palliative Medicine (Surgery) Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: HOLLY RASMUSSEN JONES
Title or Position: SECRETARY
Credential:
Phone: 479-201-4835