Provider Demographics
NPI:1396731535
Name:IOWA RIVER HOSPICE INC
Entity type:Organization
Organization Name:IOWA RIVER HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STUPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-753-7704
Mailing Address - Street 1:502 PLAZA HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4544
Mailing Address - Country:US
Mailing Address - Phone:641-753-7704
Mailing Address - Fax:641-753-0379
Practice Address - Street 1:502 PLAZA HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4544
Practice Address - Country:US
Practice Address - Phone:641-753-7704
Practice Address - Fax:641-753-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0615054Medicaid
IA61505OtherBLUECROSSBLUESHIELD
IA0615054Medicaid