Basic Information
| Provider Information | |||||||||
| NPI: | 1629405485 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARBOR LIGHT HOSPICE OF MISSOURI LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 ROOSEVELT RD STE C206 | ||||||||
| Address2: | SUITE C-206 | ||||||||
| City: | GLEN ELLYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601375851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309420100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2258 SCHUETZ RD | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631463423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146927211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2013 | ||||||||
| LastUpdateDate: | 04/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | THOME | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6309420100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | R.N. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.