Provider Demographics
NPI:1528175304
Name:HOSPICE CARE OF MIDDLETOWN, INC.
Entity type:Organization
Organization Name:HOSPICE CARE OF MIDDLETOWN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-424-2273
Mailing Address - Street 1:4418 LEWIS ST STE B
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-6183
Mailing Address - Country:US
Mailing Address - Phone:513-424-2273
Mailing Address - Fax:513-424-5450
Practice Address - Street 1:4418 LEWIS ST STE B
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6183
Practice Address - Country:US
Practice Address - Phone:513-424-2273
Practice Address - Fax:513-424-5450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0149HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2631843Medicaid
OH0149HSPOtherSTATE LICENSE ID NUMBER
OH2631843Medicaid