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General NPI Number Information
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NPI Number | 1891700720
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Entity Type | Organization
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Legal Business Name | FAMILY HOSPICE OF BELLEVILLE AREA
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5110 WEST MAIN STREET
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City | BELLEVILLE
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State | IL
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Zip | 62226-4729
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Country | US
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Telephone | 618-277-1800
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Fax | 618-277-1074
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Provider Business Mailing Address
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Address Line | 5110 WEST MAIN STREET
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City | BELLEVILLE
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State | IL
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Zip | 62226-4729
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Country | US
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Telephone | 618-277-1800
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Fax | 618-277-1074
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JIM CLINDANIEL
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Credential | LNHA
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Telephone | 618-277-1800
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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 | 2001089
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License Number State | IL
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