Organization
COUNTRYSIDE HOSPICE CARE INC
Active
Parent organization
SOLAMOR HOSPICE
Other names
SolAmore Hospice Jacksonville
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOLAMOR HOSPICE
Authorized official
MR. GLEN CAVALLO (SR. VP OF OPERATIONS)
(479) 996-5900
Entity
Organization
Contact information
Practice address
320 BRANSCOMB DR SW, SUITE D, JACKSONVILLE, AL 36265
(256) 235-2999
(256) 782-3590
Mailing address
101 SUN AVE NE, ALBUQUERQUE, NM 87109-4373
(505) 468-5604
(505) 468-4681
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PIC1579E
—
AL
Enumeration date
06/04/2006
Last updated
08/03/2011
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