Basic Information
| Provider Information | |||||||||
| NPI: | 1700881703 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOPE HOSPICE INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HOPE HOSPICE OF FULTON COUNTY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| 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: | 1476 W 18TH ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469757939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742244673 | ||||||||
| FaxNumber: | 5742244444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 12/04/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PURKEY | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5742244673 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 050098781 | IN | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 200145090A | 05 | IN | MEDICAID |