Healthcare Provider Details

I. General information

NPI: 1477007458
Provider Name (Legal Business Name): MAPLE CREEK HOSPICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S MARKET ST
SPARTA IL
62286-2062
US

IV. Provider business mailing address

301 SOVEREIGN CT
BALLWIN MO
63011-4441
US

V. Phone/Fax

Practice location:
  • Phone: 618-443-4671
  • Fax:
Mailing address:
  • Phone: 314-631-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KALYN NOEL GLODO
Title or Position: ADMINISTRATOR
Credential:
Phone: 618-443-4671