Provider Demographics
NPI:1609873769
Name:HOSPICE OF JACKSON COUNTY,INC
Entity Type:Organization
Organization Name:HOSPICE OF JACKSON COUNTY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-652-0123
Mailing Address - Street 1:PO BOX 675
Mailing Address - Street 2:611 WEST QUARRY STREET
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2125
Mailing Address - Country:US
Mailing Address - Phone:563-652-0123
Mailing Address - Fax:563-652-2181
Practice Address - Street 1:611 W QUARRY ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2125
Practice Address - Country:US
Practice Address - Phone:563-652-0123
Practice Address - Fax:563-652-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0615765Medicaid
IA0615765Medicaid