Provider Demographics
NPI:1629023676
Name:FAITH HOSPICE INCORPORATED
Entity Type:Organization
Organization Name:FAITH HOSPICE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AVA
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:WOELM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CHPN
Authorized Official - Phone:314-892-4441
Mailing Address - Street 1:4150 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1005
Mailing Address - Country:US
Mailing Address - Phone:314-892-4441
Mailing Address - Fax:314-892-4478
Practice Address - Street 1:4150 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1005
Practice Address - Country:US
Practice Address - Phone:314-892-4441
Practice Address - Fax:314-892-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO826308801Medicaid
MO826308801Medicaid