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General NPI Number Information
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NPI Number | 1396746103
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Entity Type | Organization
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Legal Business Name | BIG BEND HOSPICE, INC.
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 1723 MAHAN CENTER BLVD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5428
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Country | US
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Telephone | 850-878-5310
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Fax | 850-309-1638
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Provider Business Mailing Address
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Address Line | 1723 MAHAN CENTER BLVD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5428
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Country | US
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Telephone | 850-878-5310
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Fax | 850-309-1638
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | WILLIAM E WERTMAN
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Credential | MSW
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Telephone | 850-878-5310
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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 | 5002096
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License Number State | FL
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