1154342707 NPI number — HOSPICE OF COMPASSION, INC.

Table of content: (NPI 1154342707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154342707 NPI number — HOSPICE OF COMPASSION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF COMPASSION, 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:
Provider Other Organization Name Type Code:
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:
1154342707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
406 COURT ST
Provider Second Line Business Mailing Address:
PO BOX 1034
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52361-1024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-668-2262
Provider Business Mailing Address Fax Number:
319-668-1656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52361-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-668-2262
Provider Business Practice Location Address Fax Number:
319-668-1656
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
TAMARA
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
319-668-2262

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0615286 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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