Provider Demographics
NPI:1861136335
Name:GEISS MED HOSPICE ID LLC
Entity type:Organization
Organization Name:GEISS MED HOSPICE ID LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-315-0858
Mailing Address - Street 1:2592 N SANTIAGO BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-1862
Mailing Address - Country:US
Mailing Address - Phone:855-434-7763
Mailing Address - Fax:
Practice Address - Street 1:4301 GARRITY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9222
Practice Address - Country:US
Practice Address - Phone:657-315-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based