Provider Demographics
NPI:1427419597
Name:SAFE HAVEN HOSPICE OF SOUTHERN ILLINOIS, LLC
Entity Type:Organization
Organization Name:SAFE HAVEN HOSPICE OF SOUTHERN ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:PHILLIPPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-587-7900
Mailing Address - Street 1:622 EMERSON RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6727
Mailing Address - Country:US
Mailing Address - Phone:314-587-6727
Mailing Address - Fax:
Practice Address - Street 1:622 EMERSON RD
Practice Address - Street 2:SUITE 310
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6727
Practice Address - Country:US
Practice Address - Phone:314-587-6727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGOtherPENDING