Provider Demographics
NPI:1295472751
Name:COTTONWOOD HOSPICE, LLC
Entity type:Organization
Organization Name:COTTONWOOD HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GENRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-239-8612
Mailing Address - Street 1:1201 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-2003
Mailing Address - Country:US
Mailing Address - Phone:402-228-8501
Mailing Address - Fax:402-228-8500
Practice Address - Street 1:1201 N 10TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2003
Practice Address - Country:US
Practice Address - Phone:402-228-8501
Practice Address - Fax:402-228-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE281504OtherMEDICARE