Healthcare Provider Details

I. General information

NPI: 1215084876
Provider Name (Legal Business Name): SAFE HARBOR HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 10/12/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 W MAIN ST STE C
FREDERICKTOWN MO
63645-1143
US

IV. Provider business mailing address

PO BOX 2130
DAPHNE AL
36526-2130
US

V. Phone/Fax

Practice location:
  • Phone: 573-783-7625
  • Fax: 573-783-2126
Mailing address:
  • Phone: 205-652-6167
  • Fax: 205-742-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number1076HO
License Number StateMO

VIII. Authorized Official

Name: MR. LEWIS C. BLAIR
Title or Position: CEO
Credential:
Phone: 52-742-0028