Healthcare Provider Details

I. General information

NPI: 1629204466
Provider Name (Legal Business Name): HOSPICE OF THE GORGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 WOODS CT
HOOD RIVER OR
97031-2911
US

IV. Provider business mailing address

1630 WOODS CT
HOOD RIVER OR
97031-2911
US

V. Phone/Fax

Practice location:
  • Phone: 541-387-6449
  • Fax: 541-386-6700
Mailing address:
  • Phone: 541-387-6449
  • Fax: 541-386-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GRETCHEN HAGEN
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 541-387-6449