Provider Demographics
NPI:1376612648
Name:AMERICAN HOSPICE -- FORT PAYNE
Entity Type:Organization
Organization Name:AMERICAN HOSPICE -- FORT PAYNE
Other - Org Name:AMERICAN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:256-245-9212
Mailing Address - Street 1:103 3RD STREET NORTH WEST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968
Mailing Address - Country:US
Mailing Address - Phone:256-245-9212
Mailing Address - Fax:
Practice Address - Street 1:103 3RD STREET NORTH WEST
Practice Address - Street 2:SUITE 202
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968
Practice Address - Country:US
Practice Address - Phone:256-245-9212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based