Provider Demographics
NPI:1942202452
Name:HOSPICE OF WASHINGTON COUNTY INC
Entity Type:Organization
Organization Name:HOSPICE OF WASHINGTON COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLLENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-653-7321
Mailing Address - Street 1:948 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-2633
Mailing Address - Country:US
Mailing Address - Phone:319-653-7321
Mailing Address - Fax:319-653-4057
Practice Address - Street 1:948 E 11TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-2633
Practice Address - Country:US
Practice Address - Phone:319-653-7321
Practice Address - Fax:319-653-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0615443Medicaid
IA161544OtherWELLMARK BCBS
IA0615443Medicaid