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General NPI Number Information
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NPI Number | 1629405485
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Entity Type | Organization
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Legal Business Name | HARBOR LIGHT HOSPICE OF MISSOURI LLC
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Dates
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Enumeration Date | 10/10/2013
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 2258 SCHUETZ RD SUITE 116
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3423
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Country | US
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Telephone | 314-692-7211
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Fax |
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Provider Business Mailing Address
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Address Line | 800 ROOSEVELT RD STE C206 SUITE C-206
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City | GLEN ELLYN
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State | IL
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Zip | 60137-5851
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Country | US
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Telephone | 630-942-0100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GREGORY S THOME
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Credential | R.N.
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Telephone | 630-942-0100
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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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