Healthcare Provider Details

I. General information

NPI: 1477977700
Provider Name (Legal Business Name): ALTERNATIVE HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 GILSINN LN
FENTON MO
63026-2008
US

IV. Provider business mailing address

1749 GILSINN LN
FENTON MO
63026-2008
US

V. Phone/Fax

Practice location:
  • Phone: 636-343-3839
  • Fax: 636-343-6367
Mailing address:
  • Phone: 636-343-3839
  • Fax: 636-343-6367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number142859
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License NumberMO2001016352
License Number StateMO

VIII. Authorized Official

Name: GREG SPENCE
Title or Position: OWNER
Credential:
Phone: 636-349-2311