Basic Information
| Provider Information | |||||||||
| NPI: | 1760672638 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPICE COMPLETE, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOSPICE COMPLETE - JASPER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1458 JONES DAIRY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | JASPER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 355011458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053850200 | ||||||||
| FaxNumber: | 2053850198 | ||||||||
| Practice Location | |||||||||
| Address1: | 1458 JONES DAIRY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | JASPER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 355011458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053850200 | ||||||||
| FaxNumber: | 2053850198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2007 | ||||||||
| LastUpdateDate: | 09/04/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2052613548 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | E6404 | AL | Y | Agencies | Hospice Care, Community Based |
No ID Information.