Provider Demographics
NPI:1982601712
Name:ARKANSAS VALLEY HOSPICE INC
Entity Type:Organization
Organization Name:ARKANSAS VALLEY HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-384-8827
Mailing Address - Street 1:PO BOX 1067
Mailing Address - Street 2:118 W 4TH
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1067
Mailing Address - Country:US
Mailing Address - Phone:719-384-8827
Mailing Address - Fax:719-384-2045
Practice Address - Street 1:118 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-3604
Practice Address - Country:US
Practice Address - Phone:719-384-8827
Practice Address - Fax:719-384-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0372251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05800149Medicaid
CO061515Medicare ID - Type Unspecified