Provider Demographics
NPI:1417956558
Name:SOUTH COAST HOSPICE & PALLIATIVE CARE SERVICES INC
Entity Type:Organization
Organization Name:SOUTH COAST HOSPICE & PALLIATIVE CARE SERVICES INC
Other - Org Name:SOUTH COAST HOSPICE & PALLIATIVE CARE SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DURKEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-269-2986
Mailing Address - Street 1:1620 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2150
Mailing Address - Country:US
Mailing Address - Phone:541-269-2986
Mailing Address - Fax:541-269-0576
Practice Address - Street 1:1620 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2150
Practice Address - Country:US
Practice Address - Phone:541-269-2986
Practice Address - Fax:541-269-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1986-005251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR55693000OtherBLUE CROSS PROVIDER #
OR132220Medicaid
ORJ3986-01OtherPACIFIC SOURCE PROVIDER #
OR381530Medicare ID - Type UnspecifiedMEDICARE PROVIDER #