Basic Information
| Provider Information | |||||||||
| NPI: | 1962498675 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPICE OF MIAMI COUNTY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 SUMMIT AVE STE 101 | ||||||||
| Address2: | P. O. BOX 502 | ||||||||
| City: | TROY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453733065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373355191 | ||||||||
| FaxNumber: | 9373358841 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 SUMMIT AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453733065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373355191 | ||||||||
| FaxNumber: | 9373358841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 04/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | BOLTON | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9373355191 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 0021-HSP | OH | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 0820428 | 05 | OH | MEDICAID |