Provider Demographics
NPI:1780609396
Name:SOUTH WIND HOSPICE, INC.
Entity type:Organization
Organization Name:SOUTH WIND HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOERING
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW KS#4904
Authorized Official - Phone:620-672-7553
Mailing Address - Street 1:496 YUCCA LANE
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-0000
Mailing Address - Country:US
Mailing Address - Phone:620-672-7553
Mailing Address - Fax:620-672-7554
Practice Address - Street 1:496 YUCCA LANE
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-0000
Practice Address - Country:US
Practice Address - Phone:620-672-7553
Practice Address - Fax:620-672-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
315D00000X
KS251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100221150AMedicaid
KS171513Medicare ID - Type Unspecified