Provider Demographics
NPI:1326045055
Name:HOSPICE WITH HEART
Entity Type:Organization
Organization Name:HOSPICE WITH HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:STANE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:712-325-6802
Mailing Address - Street 1:101 E GRAHAM AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-6691
Mailing Address - Country:US
Mailing Address - Phone:712-325-6802
Mailing Address - Fax:712-322-2671
Practice Address - Street 1:101 E GRAHAM AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-6691
Practice Address - Country:US
Practice Address - Phone:712-325-6802
Practice Address - Fax:712-322-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0615807Medicaid
IA61574OtherBLUE CROSS BLUE SHIELD
IA161574Medicare ID - Type Unspecified