Provider Demographics
NPI:1003850694
Name:SOLAMOR HOSPICE CORPORATION
Entity Type:Organization
Organization Name:SOLAMOR HOSPICE CORPORATION
Other - Org Name:SOLAMOR HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-782-9230
Mailing Address - Street 1:101 SUN AVE NE
Mailing Address - Street 2:COMPLIANCE DEPARTMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4373
Mailing Address - Country:US
Mailing Address - Phone:505-468-5604
Mailing Address - Fax:505-468-4681
Practice Address - Street 1:4 OXFORD RD
Practice Address - Street 2:SUITE E4
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3855
Practice Address - Country:US
Practice Address - Phone:203-301-0489
Practice Address - Fax:203-301-0632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0022251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008014039Medicaid
CT008014039Medicaid