Provider Demographics
NPI:1194732123
Name:ARKANSAS VALLEY HOSPICE INC
Entity type:Organization
Organization Name:ARKANSAS VALLEY HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:719-384-8827
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-0408
Mailing Address - Country:US
Mailing Address - Phone:719-384-8827
Mailing Address - Fax:719-384-2045
Practice Address - Street 1:531 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1738
Practice Address - Country:US
Practice Address - Phone:719-384-8827
Practice Address - Fax:719-384-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0619251G00000X
CO170217251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05800149Medicaid
CO05800149Medicaid