Provider Demographics
NPI:1902633209
Name:HOSPICE OF DARKE COUNTY INC
Entity type:Organization
Organization Name:HOSPICE OF DARKE COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-316-0008
Mailing Address - Street 1:1350 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-2461
Mailing Address - Country:US
Mailing Address - Phone:800-417-7535
Mailing Address - Fax:937-548-7144
Practice Address - Street 1:1350 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-2461
Practice Address - Country:US
Practice Address - Phone:800-417-7535
Practice Address - Fax:937-548-7144
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPICE OF DARKE COUNTY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0820017Medicaid