Provider Demographics
NPI:1043411861
Name:XL HOSPICE, INC.
Entity Type:Organization
Organization Name:XL HOSPICE, INC.
Other - Org Name:XL PALLIATIVE CARE CONSULTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-642-9222
Mailing Address - Street 1:57 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-8155
Mailing Address - Country:US
Mailing Address - Phone:208-262-3443
Mailing Address - Fax:208-642-9224
Practice Address - Street 1:2480 HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-5536
Practice Address - Country:US
Practice Address - Phone:208-642-9222
Practice Address - Fax:208-642-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW7071041C0700X
ORLCSW14491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID19523088751OtherBUSINESS NPI
ID19523088751OtherBUSINESS NPI
ID131510Medicare ID - Type UnspecifiedMEDICARE ID