Provider Demographics
NPI:1225083660
Name:ABC HOSPICE, INC
Entity Type:Organization
Organization Name:ABC HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:BARRON
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-638-3491
Mailing Address - Street 1:266 INDUSTRIAL DR
Mailing Address - Street 2:P O BOX 1486
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-4462
Mailing Address - Country:US
Mailing Address - Phone:256-638-3491
Mailing Address - Fax:866-479-2227
Practice Address - Street 1:266 INDUSTRIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-4462
Practice Address - Country:US
Practice Address - Phone:256-638-3491
Practice Address - Fax:866-479-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11163163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPIC1626EMedicaid
ALPIC1626EMedicaid