Provider Demographics
NPI:1518962828
Name:HOSPICE OF GUERNSEY INC
Entity Type:Organization
Organization Name:HOSPICE OF GUERNSEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:740-432-7440
Mailing Address - Street 1:PO BOX 1165
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-6165
Mailing Address - Country:US
Mailing Address - Phone:740-432-7440
Mailing Address - Fax:740-432-7424
Practice Address - Street 1:9711 E PIKE RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-8936
Practice Address - Country:US
Practice Address - Phone:740-432-7440
Practice Address - Fax:740-432-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0019HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH880434OtherWORKERS COMPENSATION
OHBC00000W98OtherANTHEM PROVIDER #
OHW98OtherCMIC
OH0820240Medicaid
OH061511OtherMEDICAL MUTUAL PROVIDER N
OH361511Medicare ID - Type UnspecifiedMEDICARE ID