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General NPI Number Information
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NPI Number | 1639175599
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Entity Type | Organization
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Legal Business Name | BEACON OF HOPE HOSPICE, INC.
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1020 WEST 35TH STREET
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City | DAVENPORT
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State | IA
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Zip | 52806-4440
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Country | US
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Telephone | 563-391-6933
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Fax | 563-391-5104
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Provider Business Mailing Address
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Address Line | 2191 LEMAY FERRY RD SUITE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63125-2408
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Country | US
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Telephone | 314-815-3500
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Fax | 314-815-3207
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MRS. DAWN E. MULLINS
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Credential | R.N., B.S.N.
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Telephone | 314-815-3000
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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 | 41537899
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 2698587
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License Number State | IA
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