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General NPI Number Information
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NPI Number | 1164698338
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Entity Type | Organization
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Legal Business Name | MADISON COUNTY HOSPITAL HOSPICE
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 212 N MAIN ST
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City | LONDON
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State | OH
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Zip | 43140-1115
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Country | US
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Telephone | 740-845-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 212 N MAIN ST
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City | LONDON
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State | OH
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Zip | 43140-1115
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. FRED KOLB
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Credential |
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Telephone | 740-845-7000
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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 | 0036HSP
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License Number State | OH
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