Provider Demographics
NPI:1720309412
Name:HEART OF HOSPICE LLC
Entity Type:Organization
Organization Name:HEART OF HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JORDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, CNP
Authorized Official - Phone:541-386-1942
Mailing Address - Street 1:205 WASCO LOOP
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1266
Mailing Address - Country:US
Mailing Address - Phone:541-386-1942
Mailing Address - Fax:541-386-1728
Practice Address - Street 1:205 WASCO LOOP
Practice Address - Street 2:SUITE 202
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1266
Practice Address - Country:US
Practice Address - Phone:541-386-1942
Practice Address - Fax:541-386-1728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEART OF HOSPICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-16
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR243105253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR243105Medicaid
OR381554Medicare PIN