Provider Demographics
NPI:1427090968
Name:HOSPICE DEL VALLE, INC.
Entity type:Organization
Organization Name:HOSPICE DEL VALLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-589-9019
Mailing Address - Street 1:514 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2644
Mailing Address - Country:US
Mailing Address - Phone:719-589-9019
Mailing Address - Fax:719-589-5094
Practice Address - Street 1:514 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2644
Practice Address - Country:US
Practice Address - Phone:719-589-9019
Practice Address - Fax:719-589-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0981251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05800024Medicaid
CO05800024Medicaid