Provider Demographics
NPI:1639175599
Name:BEACON OF HOPE HOSPICE, INC.
Entity Type:Organization
Organization Name:BEACON OF HOPE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:314-815-3000
Mailing Address - Street 1:2191 LEMAY FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-2408
Mailing Address - Country:US
Mailing Address - Phone:314-815-3500
Mailing Address - Fax:314-815-3207
Practice Address - Street 1:1020 WEST 35TH STREET
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-4440
Practice Address - Country:US
Practice Address - Phone:563-391-6933
Practice Address - Fax:563-391-5104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2698587251G00000X
IL41537899251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0615526OtherMEDICAID
IL=========001Medicaid
IA0615526OtherMEDICAID