Provider Demographics
NPI:1740260751
Name:HOSPICE OF MORROW COUNTY INC.
Entity type:Organization
Organization Name:HOSPICE OF MORROW COUNTY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRACLE
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:419-946-9822
Mailing Address - Street 1:228 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1450
Mailing Address - Country:US
Mailing Address - Phone:419-946-9822
Mailing Address - Fax:419-946-9971
Practice Address - Street 1:228 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1450
Practice Address - Country:US
Practice Address - Phone:419-946-9822
Practice Address - Fax:419-946-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0062HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000232631OtherANTHEM BLUECROSS/B.SHIELD
OHV552P-5758OtherDEPT OF VET AFFAIRS
OH0948087Medicaid
OH000000232631OtherANTHEM BLUECROSS/B.SHIELD
OH=========002OtherMEDICAL MUTUAL OF OHIO