Healthcare Provider Details

I. General information

NPI: 1073029096
Provider Name (Legal Business Name): HOPE PALLIATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10754 INDIAN HEAD INDUSTRIAL BLVD
SAINT LOUIS MO
63132-1102
US

IV. Provider business mailing address

10754 INDIAN HEAD INDUSTRIAL BLVD
SAINT LOUIS MO
63132-1102
US

V. Phone/Fax

Practice location:
  • Phone: 314-984-9800
  • Fax:
Mailing address:
  • Phone: 314-984-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number2013006531
License Number StateMO

VIII. Authorized Official

Name: MR. MICHAEL FULTON MCNULTY
Title or Position: PRESIDENT
Credential:
Phone: 314-984-9800