Hospice of Marshall County, Inc.

Contacts

Phone	+1 256-891-7724
Fax	2568917754

Authorized person

Name	MRS. RHONDA SLATON OSBORNE
Role	CEO
Phone	2568917724

Taxonomy

Taxonomy Code	251G00000X - Community Based Hospice Care Agency
License Number	10248
State	AL
Is Primary	Yes

Other Provider Identifiers

Issuer	BLUECROSSBLUESHIELD OF AL
Number	010353
State	AL
Issuer	MEDICAID
Number	PIC1513E
State	AL

Contact Information

POC	RHONDA OSBORNE
Phone	+1 256-891-7724
Fax	+1 256-891-7754
Address	408 MARTLING RD, ALBERTVILLE, AL, 35951 7208, UNITED STATES

Ownership of Offeror Information

Highest Level Owner	Information not Available

Immediate Level Owner	Information not Available

List of Offerors (0)	Information not Available

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1999-07-01
Business code	623000
Sponsor’s telephone number	2568917724
Plan sponsor’s address	408 MARTLING RD, ALBERTVILLE, AL, 359517208

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1999-07-01
Business code	623000
Sponsor’s telephone number	2568917724
Plan sponsor’s address	408 MARTLING RD, ALBERTVILLE, AL, 359517208

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1999-07-01
Business code	623000
Sponsor’s telephone number	2568917724
Plan sponsor’s address	408 MARTLING RD, ALBERTVILLE, AL, 359517208

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1999-07-01
Business code	623000
Sponsor’s telephone number	2568917724
Plan sponsor’s address	408 MARTLING RD, ALBERTVILLE, AL, 359517208

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1999-07-01
Business code	623000
Sponsor’s telephone number	2568917724
Plan sponsor’s address	408 MARTLING RD, ALBERTVILLE, AL, 359517208

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1999-07-01
Business code	623000
Sponsor’s telephone number	2568917724
Plan sponsor’s address	408 MARTLING RD, ALBERTVILLE, AL, 359517208

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1999-07-01
Business code	623000
Sponsor’s telephone number	2568917724
Plan sponsor’s address	408 MARTLING RD, ALBERTVILLE, AL, 359517208

Signature of

Role	Plan administrator
Date	2018-07-11
Name of individual signing	BRENDA MAYHALL

Three-digit plan number (PN)	001
Effective date of plan	1999-07-01
Business code	623000
Sponsor’s telephone number	2568917724
Plan sponsor’s address	408 MARTLING RD, ALBERTVILLE, AL, 359517208

Signature of

Role	Plan administrator
Date	2018-07-09
Name of individual signing	BRENDA MAYHALL

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1999-07-01
Business code	623000
Sponsor’s telephone number	2568917724
Plan sponsor’s address	408 MARTLING RD, ALBERTVILLE, AL, 359517208

Signature of

Role	Plan administrator
Date	2017-07-01
Name of individual signing	RHONDA OSBORNE

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1999-07-01
Business code	623000
Sponsor’s telephone number	2568917724
Plan sponsor’s address	408 MARTLING ROAD, ALBERTVILLE, AL, 35951

Signature of

Role	Plan administrator
Date	2016-07-06
Name of individual signing	RHONDA OSBORNE