Provider Demographics
NPI:1164411450
Name:HOPE HOSPICE AND PALLIATIVE CARE INC
Entity Type:Organization
Organization Name:HOPE HOSPICE AND PALLIATIVE CARE INC
Other - Org Name:HOPE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SYRYCZUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-748-3434
Mailing Address - Street 1:537 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1610
Mailing Address - Country:US
Mailing Address - Phone:715-748-3434
Mailing Address - Fax:715-748-1268
Practice Address - Street 1:537 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1610
Practice Address - Country:US
Practice Address - Phone:715-748-3434
Practice Address - Fax:715-748-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43180200251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43180200Medicaid
WI521517Medicare Oscar/Certification