MEDICARE: DOUGLAS GARDENS HOSPICE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	50370965	FL

General Provider Information

NPI Number	:	1578554143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS GARDENS HOSPICE, INC.

Provider Business Mailing Address
First Line	:	5200 NE 2ND AVE
Second Line	:	3RD FLOOR ABLIN
City	:	MIAMI
State	:	FL
Zip	:	33137-2706
Country	:	US
Telephone Number	:	305-762-3883
Fax Number	:	305-795-8423

Provider Business Practice Location Address
First Line	:	5200 NE 2ND AVE
Second Line	:	3RD FLOOR ABLIN
City	:	MIAMI
State	:	FL
Zip	:	33137-2706
Country	:	US
Telephone Number	:	305-762-3883
Fax Number	:	305-795-8423

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. JODY GROSS
Credential	:	RN, MSN, OCN
Telephone Number	:	305-762-3883

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	08/22/2020

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