1588923759 NPI number — COMFORT HOSPICE OF MISSOURI, LLC

Table of content: (NPI 1588923759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588923759 NPI number — COMFORT HOSPICE OF MISSOURI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMFORT HOSPICE OF MISSOURI, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMFORT HOSPICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588923759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 99278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48099-9278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-824-6000
Provider Business Mailing Address Fax Number:
855-618-6655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8706 MANCHESTER RD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63144-2733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-266-0950
Provider Business Practice Location Address Fax Number:
855-845-1847
Provider Enumeration Date:
05/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
RAJIV
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CEO/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
248-824-6609

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1588923759 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 213-6HO . This is a "STATE OF MISSOURI HOSPICE LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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