MEDICARE: DEER VALLEY HOSPICE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1720548522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEER VALLEY HOSPICE CARE LLC

Provider Business Mailing Address
First Line	:	8600 AIRPORT RD STE 103
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-1937
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 AIRPORT RD STE 103
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-1937
Country	:	US
Telephone Number	:	314-396-2211
Fax Number	:	314-521-3559

Authorized Official
Title or Position	:	HUMAN RESOURCES MANAGER
Name	:	MS. DENISE WASHINGTON
Credential	:
Telephone Number	:	314-219-1207

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	03/20/2019

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