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General NPI Number Information
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NPI Number | 1174060529
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Entity Type | Organization
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Legal Business Name | AVALON HOSPICE MISSOURI, LLC
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 5615 PERSHING AVE SUITE 20
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City | SAINT LOUIS
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State | MO
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Zip | 63112-1757
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Country | US
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Telephone | 314-328-6700
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Fax | 314-546-4400
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Provider Business Mailing Address
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Address Line | 655 BRAWLEY SCHOOL RD SUITE 200
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City | MOORESVILLE
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State | NC
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Zip | 28117-9125
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Country | US
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Telephone | 704-664-2876
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Fax | 704-664-1306
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Authorized Official
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Title or Position | VP LEGAL AFFAIRS
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Name | JESSICA KLEBERG
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Credential |
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Telephone | 704-664-2876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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