Healthcare Provider Details

I. General information

NPI: 1316654650
Provider Name (Legal Business Name): CROSSROADS HOSPICE OF ST LOUIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15450 S OUTER 40 RD STE 100
CHESTERFIELD MO
63017-2062
US

IV. Provider business mailing address

10810 E 45TH ST STE 300
TULSA OK
74146-3816
US

V. Phone/Fax

Practice location:
  • Phone: 314-801-6960
  • Fax: 314-801-6999
Mailing address:
  • Phone: 918-627-6846
  • Fax: 918-627-6856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CLAYTON LEE FARMER
Title or Position: CFO/COO
Credential:
Phone: 918-627-6846