Provider Demographics
NPI:1629204466
Name:HOSPICE OF THE GORGE, INC.
Entity type:Organization
Organization Name:HOSPICE OF THE GORGE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:541-387-6449
Mailing Address - Street 1:1630 WOODS CT
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-2911
Mailing Address - Country:US
Mailing Address - Phone:541-387-6449
Mailing Address - Fax:541-386-6700
Practice Address - Street 1:1630 WOODS CT
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2911
Practice Address - Country:US
Practice Address - Phone:541-387-6449
Practice Address - Fax:541-386-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132014Medicaid
1750448916OtherNPI NUMBER
WA3990330Medicaid
OR132014Medicaid