Provider Demographics
NPI:1417068461
Name:CHRISTIAN HEALTH CARE HOSPICE, INC.
Entity Type:Organization
Organization Name:CHRISTIAN HEALTH CARE HOSPICE, INC.
Other - Org Name:REGIONAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-464-0200
Mailing Address - Street 1:1328 E EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4400
Mailing Address - Country:US
Mailing Address - Phone:417-832-0577
Mailing Address - Fax:417-831-9566
Practice Address - Street 1:1328 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4400
Practice Address - Country:US
Practice Address - Phone:417-832-0577
Practice Address - Fax:417-831-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102-6HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO828682906Medicaid
261578Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER