Provider Demographics
NPI:1598815839
Name:HOSPICE OF ST. FRANCIS, INC.
Entity Type:Organization
Organization Name:HOSPICE OF ST. FRANCIS, INC.
Other - Org Name:ST FRANCIS REFLECTIONS LIFESTAGE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGE CARE/SYSTEMS SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KAMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-522-8612
Mailing Address - Street 1:1250 GRUMMAN PL STE B
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-7927
Mailing Address - Country:US
Mailing Address - Phone:321-269-4240
Mailing Address - Fax:321-269-5428
Practice Address - Street 1:1250 GRUMMAN PL STE B
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-7927
Practice Address - Country:US
Practice Address - Phone:321-269-4240
Practice Address - Fax:321-269-5428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5029096251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL087255500Medicaid
FL101534Medicare ID - Type Unspecified