Provider Demographics
NPI:1083156194
Name:SPOKANE HEALTHCARE, INC.
Entity Type:Organization
Organization Name:SPOKANE HEALTHCARE, INC.
Other - Org Name:RIVER CITY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOCHNOUR
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:208-401-1365
Mailing Address - Street 1:927 E POLSTON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9390
Mailing Address - Country:US
Mailing Address - Phone:208-777-2489
Mailing Address - Fax:208-777-2499
Practice Address - Street 1:927 E POLSTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9390
Practice Address - Country:US
Practice Address - Phone:208-777-2489
Practice Address - Fax:208-777-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
131561Medicare Oscar/Certification