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General NPI Number Information
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NPI Number | 1245276781
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Entity Type | Organization
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Legal Business Name | COMMUNITY LOVING CARE HOSPICE, L.L.C.
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 251 E PEARCE BLVD
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City | WENTZVILLE
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State | MO
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Zip | 63385-1529
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Country | US
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Telephone | 636-639-6280
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Fax | 636-639-6317
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Provider Business Mailing Address
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Address Line | 251 E PEARCE BLVD
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City | WENTZVILLE
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State | MO
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Zip | 63385-1529
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Country | US
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Telephone | 636-639-6280
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Fax | 636-639-6317
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Authorized Official
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Title or Position | CHIEF OPERATING MANAGER
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Name | MR. WAYNE LARRY DANDRIDGE
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Credential |
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Telephone | 636-639-6280
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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 | MO
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