MEDICARE: HEART OF HOSPICE LLC

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	253Z00000X	In Home Supportive Care Agency	243105	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720309412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART OF HOSPICE LLC

Provider Business Mailing Address
First Line	:	205 WASCO LOOP
Second Line	:	SUITE 202
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1266
Country	:	US
Telephone Number	:	541-386-1942
Fax Number	:	541-386-1728

Provider Business Practice Location Address
First Line	:	205 WASCO LOOP
Second Line	:	SUITE 202
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1266
Country	:	US
Telephone Number	:	541-386-1942
Fax Number	:	541-386-1728

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JORDANA GOATCHER
Credential	:	BSN, RN, CNP
Telephone Number	:	541-386-1942

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	03/10/2011

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Directions to “HEART OF HOSPICE LLC ” Practice Location

Language	Start Address	Practice Location

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