1912359118 NPI number — OPTUM PALLIATIVE AND HOSPICE CARE, INC.

Table of content: (NPI 1912359118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912359118 NPI number — OPTUM PALLIATIVE AND HOSPICE CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTUM PALLIATIVE AND HOSPICE CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EVERCARE HOSPICE, INC.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912359118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1009 WINDCROSS CT
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-2678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-224-5443
Provider Business Mailing Address Fax Number:
844-727-9218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6455 S YOSEMITE ST
Provider Second Line Business Practice Location Address:
6TH FLOOR
Provider Business Practice Location Address City Name:
GREENWOOD VILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-5139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-265-1100
Provider Business Practice Location Address Fax Number:
844-727-9218
Provider Enumeration Date:
07/12/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ENDERLE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
SR. VICE PRESIDENT/CFO
Authorized Official Telephone Number:
860-221-0793

Provider Taxonomy Codes

  • Taxonomy code: 207PH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2081H0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)