Provider Demographics
NPI:1003872276
Name:AVOW HOSPICE INC
Entity Type:Organization
Organization Name:AVOW HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-261-4404
Mailing Address - Street 1:1205 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-5028
Mailing Address - Country:US
Mailing Address - Phone:239-304-1600
Mailing Address - Fax:239-280-5998
Practice Address - Street 1:1095 WHIPPOORWILL LN
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-3847
Practice Address - Country:US
Practice Address - Phone:239-261-4404
Practice Address - Fax:239-280-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5022096251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU02OtherBLUE CROSS BLUE SHIELD #
FL087537600Medicaid
FL087537600Medicaid