NPIMap

Organization Active NPI

Avow Hospice Inc

  • Community Based Hospice Care Agency
  • Naples, FL
National Provider Identifier
1003872276
Registry record updated Mar 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
5022096 Issued in FL
Legal business name
AVOW HOSPICE INC
Practice address
1095 Whippoorwill LN
Naples, FL 34105-3847
Phone
(239) 261-4404
Fax
(239) 280-5998
NPI assigned
Apr 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Phyllis Hall
Title
Cfo
Phone
(239) 261-4404

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 5022096 FL Primary

Addresses

Primary practice location

1095 Whippoorwill LN
Naples, FL 34105-3847

Mailing address

1205 Whippoorwill LN
Naples, FL 34105-5028
Phone (239) 304-1600

Other identifiers 2

IdentifierTypeStateIssuer
U02OtherFLBLUE CROSS BLUE SHIELD #
087537600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040216000832 FL Part A Provider - Hospice 5597650994 Practice locations: Naples, FL

Hospice certification: CCN 101528

Legal name
AVOW HOSPICE INC
Doing business as
HOSPICE OF NAPLES INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 24, 1987
Last certification
Aug 6, 2019
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Apr 5, 1982 in FL
Enrollment address
1095 Whippoorwill LN
Naples, FL 34105-3847

Care Compare: Hospice

Medicare Care Compare
Listed as
Avow Hospice IncCCN 101528
Ownership
Non-Profit
Certified
Sep 24, 1987
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0883726Avow Hospice Inc1095 Whippoorwill Lane, Naples, FL 34105Certificate of waiverMar 15, 2028

National Provider Directory

National Provider Directory

Locations

1095 Whippoorwill Ln
#B
Naples, FL 34105

1095 Whippoorwill Ln
Naples, FL 34105
Phone (236) 261-5786

1223 Whippoorwill Ln
Naples, FL 34105
Phone (239) 261-4404

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jaysen F Roa Individual Corporate OfficerPresident and Ceo Oct 15, 2015 50%
Rebecca a Molina Individual W-2 Managing Employee May 11, 2009
Cynthia Nehrkorn Individual W-2 Managing EmployeeMD; Apr 1, 2003 50%
Phyllis Hall Individual Corporate OfficerCfo Oct 15, 2015 5%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

Affiliated clinicians 35

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 35

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678406400000",
    "number": "1003872276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 WHIPPOORWILL LN",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341055028",
            "telephone_number": "239-304-1600",
            "fax_number": "239-280-5998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 WHIPPOORWILL LN",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341053847",
            "telephone_number": "239-261-4404",
            "fax_number": "239-280-5998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVOW HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "239-261-4404",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "FL",
            "license": "5022096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD #",
            "identifier": "U02",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "087537600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Naples, FL

Sources for this page

Verify at the official NPI Registry.