Provider Demographics
NPI:1750329355
Name:HOSPICE OF THE SHOALS, INC.
Entity Type:Organization
Organization Name:HOSPICE OF THE SHOALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:N
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MBA
Authorized Official - Phone:256-767-6699
Mailing Address - Street 1:115 FAIRGROUND RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1283
Mailing Address - Country:US
Mailing Address - Phone:256-767-6699
Mailing Address - Fax:256-767-3116
Practice Address - Street 1:115 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1283
Practice Address - Country:US
Practice Address - Phone:256-767-6699
Practice Address - Fax:256-767-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11688251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPIC1530EMedicaid
AL43113OtherBLUE CROSS/BLUE SHIELD
ALPIC1530EMedicaid