Provider Demographics
NPI:1134125669
Name:IHC HOSPICE INC
Entity Type:Organization
Organization Name:IHC HOSPICE INC
Other - Org Name:ISLAND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOLCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-629-2727
Mailing Address - Street 1:PO BOX 8011
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31412-8011
Mailing Address - Country:US
Mailing Address - Phone:912-629-2727
Mailing Address - Fax:912-234-1718
Practice Address - Street 1:300 NEW RIVER PKWY
Practice Address - Street 2:STE 7
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4450
Practice Address - Country:US
Practice Address - Phone:843-208-3660
Practice Address - Fax:843-208-3464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC115251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP059Medicaid
SCHSP059Medicaid