Provider Demographics
NPI:1558150862
Name:BLACK HILLS HOSPICE
Entity type:Organization
Organization Name:BLACK HILLS HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAITHCOAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-370-2013
Mailing Address - Street 1:529 KANSAS CITY ST STE 203
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3693
Mailing Address - Country:US
Mailing Address - Phone:605-223-0011
Mailing Address - Fax:
Practice Address - Street 1:529 KANSAS CITY ST STE 203
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3693
Practice Address - Country:US
Practice Address - Phone:605-223-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based