Provider Demographics
NPI:1578554143
Name:DOUGLAS GARDENS HOSPICE, INC.
Entity Type:Organization
Organization Name:DOUGLAS GARDENS HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, OCN
Authorized Official - Phone:305-762-3883
Mailing Address - Street 1:5200 NE 2ND AVE
Mailing Address - Street 2:3RD FLOOR ABLIN
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2706
Mailing Address - Country:US
Mailing Address - Phone:305-762-3883
Mailing Address - Fax:305-795-8423
Practice Address - Street 1:5200 NE 2ND AVE
Practice Address - Street 2:3RD FLOOR ABLIN
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2706
Practice Address - Country:US
Practice Address - Phone:305-762-3883
Practice Address - Fax:305-795-8423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50370965251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101543Medicare ID - Type UnspecifiedPROVIDER NUMBER