Provider Demographics
NPI:1689761868
Name:HOSPICE OF INTEGRATED HEALTH SERVICES OF DISTRICT VIIB INC
Entity Type:Organization
Organization Name:HOSPICE OF INTEGRATED HEALTH SERVICES OF DISTRICT VIIB INC
Other - Org Name:SAMARITAN CARE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HINKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-514-1300
Mailing Address - Street 1:930 RIDGEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9390
Mailing Address - Country:US
Mailing Address - Phone:410-773-1000
Mailing Address - Fax:
Practice Address - Street 1:1300 N SEMORAN BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3557
Practice Address - Country:US
Practice Address - Phone:407-514-1300
Practice Address - Fax:407-514-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL150006600Medicaid
101540Medicare Oscar/Certification