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General NPI Number Information
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NPI Number | 1164426433
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Entity Type | Organization
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Legal Business Name | HOSPICE OF JEFFERSON COUNTY, INC.
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 1398 GOTHAM STREET
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City | WATERTOWN
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State | NY
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Zip | 13601
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Country | US
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Telephone | 315-788-7323
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Fax | 315-788-9653
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Provider Business Mailing Address
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Address Line | 1398 GOTHAM STREET
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City | WATERTOWN
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State | NY
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Zip | 13601
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Country | US
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Telephone | 315-788-7323
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Fax | 315-788-9653
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Authorized Official
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Title or Position | CEO
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Name | ANNA PATTERSON
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Credential |
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Telephone | 315-788-7323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 2201501F
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License Number State | NY
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