Provider Demographics
NPI:1952308751
Name:XL HOSPICE INC
Entity Type:Organization
Organization Name:XL HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-642-9222
Mailing Address - Street 1:2480 HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-5536
Mailing Address - Country:US
Mailing Address - Phone:208-642-9222
Mailing Address - Fax:208-642-9224
Practice Address - Street 1:2480 HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-5536
Practice Address - Country:US
Practice Address - Phone:208-642-9222
Practice Address - Fax:208-642-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0001449710251G00000X
OR0699275-7251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0026593Medicaid
ID131510Medicare Oscar/Certification