Healthcare Provider Details

I. General information

NPI: 1619420668
Provider Name (Legal Business Name): FAIRHOPE HOSPICE & PALLIATIVE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 SELLS RD
LANCASTER OH
43130-3461
US

IV. Provider business mailing address

282 SELLS RD
LANCASTER OH
43130-3461
US

V. Phone/Fax

Practice location:
  • Phone: 740-654-7077
  • Fax: 740-475-0376
Mailing address:
  • Phone: 740-654-7077
  • Fax: 740-475-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN GLASURE
Title or Position: CEO
Credential: LSW
Phone: 740-654-7077