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General NPI Number Information
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NPI Number | 1477190809
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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 | 12/04/2019
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 531 WASHINGTON ST STE 1100
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City | WATERTOWN
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State | NY
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Zip | 13601-4037
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Country | US
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Telephone | 315-755-6086
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Fax | 315-755-6092
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Provider Business Mailing Address
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Address Line | 1398 GOTHAM ST
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City | WATERTOWN
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State | NY
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Zip | 13601-9704
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Country | US
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Telephone | 315-788-7323
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | FRANCES LYN SOURWINE
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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 | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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