Provider Demographics
NPI:1477190809
Name:HOSPICE OF JEFFERSON COUNTY, INC.
Entity Type:Organization
Organization Name:HOSPICE OF JEFFERSON COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:SOURWINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-788-7323
Mailing Address - Street 1:1398 GOTHAM ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9704
Mailing Address - Country:US
Mailing Address - Phone:315-788-7323
Mailing Address - Fax:
Practice Address - Street 1:531 WASHINGTON ST STE 1100
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4037
Practice Address - Country:US
Practice Address - Phone:315-755-6086
Practice Address - Fax:315-755-6092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPICE OF JEFFERSON COUNTY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty