Healthcare Provider Details

I. General information

NPI: 1922386689
Provider Name (Legal Business Name): PASSAGES HOSPICE OF MISSOURI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S 6TH ST SUITE 500
SAINT LOUIS MO
63104-3602
US

IV. Provider business mailing address

1120 S 6TH ST SUITE 500
SAINT LOUIS MO
63104-3602
US

V. Phone/Fax

Practice location:
  • Phone: 815-674-0292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. SETH GILLMAN
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 630-824-0400