Basic Information
| Provider Information | |||||||||
| NPI: | 1720679319 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EH HOSPICE OF THE WEST, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | ENHABIT HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6688 N CENTRAL EXPY STE 1300 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752063950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142396500 | ||||||||
| FaxNumber: | 2142396581 | ||||||||
| Practice Location | |||||||||
| Address1: | 4024 LARAMIE ST | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820012064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076345970 | ||||||||
| FaxNumber: | 3076345384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2021 | ||||||||
| LastUpdateDate: | 07/03/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARLISLE | ||||||||
| AuthorizedOfficialFirstName: | CRISSY | ||||||||
| AuthorizedOfficialMiddleName: | BUCHANAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2142396500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ENHABIT, INC. | ||||||||
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| NPICertificationDate: | 07/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.