Healthcare Provider Details

I. General information

NPI: 1043203201
Provider Name (Legal Business Name): TWIN LAKES HOSPICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E OHIO ST
CLINTON MO
64735
US

IV. Provider business mailing address

725 E OHIO ST
CLINTON MO
64735-2357
US

V. Phone/Fax

Practice location:
  • Phone: 660-890-2014
  • Fax: 660-890-2018
Mailing address:
  • Phone: 660-890-2014
  • Fax: 660-890-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number015-8HO
License Number StateMO

VIII. Authorized Official

Name: MR. TONY B CURTIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 660-890-2014