Provider Demographics
NPI:1164607255
Name:THREE RIVERS HOSPICE, INC.
Entity Type:Organization
Organization Name:THREE RIVERS HOSPICE, INC.
Other - Org Name:THREE RIVERS HOSPICE LEAVENWORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHIRRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1276
Mailing Address - Street 1:731 N MAIN ST
Mailing Address - Street 2:P.O. BOX 1210
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-2151
Mailing Address - Country:US
Mailing Address - Phone:573-471-1276
Mailing Address - Fax:573-472-8504
Practice Address - Street 1:419 SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-1954
Practice Address - Country:US
Practice Address - Phone:913-758-1700
Practice Address - Fax:913-758-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based