Healthcare Provider Details

I. General information

NPI: 1134848625
Provider Name (Legal Business Name): DAVIS HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E 3RD ST
GILLETTE WY
82716-4023
US

IV. Provider business mailing address

902 E 3RD ST
GILLETTE WY
82716-4023
US

V. Phone/Fax

Practice location:
  • Phone: 307-756-9200
  • Fax: 888-715-6736
Mailing address:
  • Phone: 307-756-9200
  • Fax: 888-715-6736

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 State

VIII. Authorized Official

Name: MRS. LACY L DAVIS
Title or Position: RN ADMINISTRATOR
Credential: RN
Phone: 307-756-9200