Provider Demographics
NPI:1760475255
Name:HOSPICE OF SPOKANE
Entity Type:Organization
Organization Name:HOSPICE OF SPOKANE
Other - Org Name:SPOKANE PALLIATIVE CARE & MOBILE MEDICINE OF SPOKANE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:509-456-0438
Mailing Address - Street 1:121 S ARTHUR ST
Mailing Address - Street 2:PO BOX 2215
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2253
Mailing Address - Country:US
Mailing Address - Phone:509-456-0438
Mailing Address - Fax:509-458-0359
Practice Address - Street 1:121 S ARTHUR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2253
Practice Address - Country:US
Practice Address - Phone:509-456-0438
Practice Address - Fax:509-458-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS-337251G00000X
WAIHS FS 00000337315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3990165Medicaid
WA3990165Medicaid
WA501503Medicare Oscar/Certification