MEDICARE: LESTER DIERKSEN MEMORIAL 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1952558611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESTER DIERKSEN MEMORIAL HOSPICE, LLC

Provider Business Mailing Address
First Line	:	500 FAULCONER DR STE 200
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22903-5089
Country	:	US
Telephone Number	:	434-977-9711
Fax Number	:	434-235-4142

Provider Business Practice Location Address
First Line	:	3648 N HIGHWAY 7 STE E
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71909-9311
Country	:	US
Telephone Number	:	501-318-1500
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	JESSE R MOORE
Credential	:
Telephone Number	:	857-331-6271

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	04/21/2025

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