Provider Demographics
NPI:1558311548
Name:SPENCER COUNTY HOSPICE, INC.
Entity Type:Organization
Organization Name:SPENCER COUNTY HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:812-649-9151
Mailing Address - Street 1:225 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635-1415
Mailing Address - Country:US
Mailing Address - Phone:812-649-9151
Mailing Address - Fax:812-649-5186
Practice Address - Street 1:225 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1415
Practice Address - Country:US
Practice Address - Phone:812-649-9151
Practice Address - Fax:812-649-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
151569Medicare ID - Type Unspecified