Provider Demographics
NPI:1053664821
Name:SIGNATURE HOSPICE LLC
Entity Type:Organization
Organization Name:SIGNATURE HOSPICE LLC
Other - Org Name:ONESOURCE HOMECARE & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-524-0685
Mailing Address - Street 1:1980 BIRDIE THOMPSON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2755
Mailing Address - Country:US
Mailing Address - Phone:208-478-1448
Mailing Address - Fax:208-478-1449
Practice Address - Street 1:2052 JENNIE LEE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7000
Practice Address - Country:US
Practice Address - Phone:208-227-0478
Practice Address - Fax:208-227-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based