=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770062267
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE PALLIATIVE CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2018
-----------------------------------------------------
Last Update Date | 08/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10754 INDIAN HEAD INDUSTRIAL BLVD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63132-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-984-9800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10754 INDIAN HEAD INDUSTRIAL BLVD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63132-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-984-9800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | LAURA ANN BILBREY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-984-9800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0000X
-----------------------------------------------------
Taxonomy Name | Pain Management Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------