Provider Demographics
NPI:1558933440
Name:ANCORA HOSPICE & PALLIATIVE SERVICES, LLC
Entity type:Organization
Organization Name:ANCORA HOSPICE & PALLIATIVE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLIGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-452-2672
Mailing Address - Street 1:660 E FRANKLIN RD STE 140
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2914
Mailing Address - Country:US
Mailing Address - Phone:208-452-2672
Mailing Address - Fax:208-452-2673
Practice Address - Street 1:660 E FRANKLIN RD STE 140
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2914
Practice Address - Country:US
Practice Address - Phone:208-992-2672
Practice Address - Fax:208-992-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500806451Medicaid