Basic Information
| Provider Information | |||||||||
| NPI: | 1679779367 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOPE HOSPICE, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HOPE HOME CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 621 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469750621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742244673 | ||||||||
| FaxNumber: | 5742244444 | ||||||||
| Practice Location | |||||||||
| Address1: | 2316 E STATE RD 14 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742244673 | ||||||||
| FaxNumber: | 5742244444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2007 | ||||||||
| LastUpdateDate: | 03/26/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PAULIK | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5742244673 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOPE HOSPICE, INC. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | IN | N | Agencies | Home Health | 251E00000X | 11-005301-1 | IN | Y | Agencies | Home Health |
No ID Information.