Provider Demographics
NPI:1801890892
Name:HOSPICE OF DUBUQUE
Entity type:Organization
Organization Name:HOSPICE OF DUBUQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-582-1220
Mailing Address - Street 1:1670 JOHN F KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-5106
Mailing Address - Country:US
Mailing Address - Phone:563-582-1220
Mailing Address - Fax:563-582-8089
Practice Address - Street 1:1670 JOHN F KENNEDY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-5106
Practice Address - Country:US
Practice Address - Phone:563-582-1220
Practice Address - Fax:563-582-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2001618251G00000X
WI562251G00000X
IA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3000738OtherMEDICAL ASSOCIATES HEALTH
WI43187800Medicaid
IA61514OtherWELLMARK BCBS OF IOWA
IA0615146Medicaid
IA61514OtherWELLMARK BCBS OF IOWA
IA=========001OtherSELF INSURED SERVICES CO.
IA=========01OtherJOHN DEERE HEALTH CARE
161514Medicare ID - Type Unspecified