Provider Demographics
NPI:1376510065
Name:HALIFAX HOSPICE INC
Entity Type:Organization
Organization Name:HALIFAX HOSPICE INC
Other - Org Name:HOSPICE OF VOLUSIA FLAGLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:F
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-322-4701
Mailing Address - Street 1:3800 WOODBRIAR TRAIL
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-9626
Mailing Address - Country:US
Mailing Address - Phone:386-322-4701
Mailing Address - Fax:386-322-4702
Practice Address - Street 1:3800 WOODBRIAR TRAIL
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-9626
Practice Address - Country:US
Practice Address - Phone:386-322-4701
Practice Address - Fax:386-322-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5034096251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL087523600Medicaid
FL087523600Medicaid