Provider Demographics
NPI:1649653726
Name:DOVE HOSPICE CORPORATION
Entity type:Organization
Organization Name:DOVE HOSPICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-420-0877
Mailing Address - Street 1:108 E 3RD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-6202
Mailing Address - Country:US
Mailing Address - Phone:575-420-0877
Mailing Address - Fax:575-627-5934
Practice Address - Street 1:108 E 3RD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6202
Practice Address - Country:US
Practice Address - Phone:575-420-0877
Practice Address - Fax:575-627-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5066956251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based