Provider Demographics
NPI:1821025826
Name:PREFERRED HOSPICE OF MISSOURI NORTHEAST LLC
Entity Type:Organization
Organization Name:PREFERRED HOSPICE OF MISSOURI NORTHEAST LLC
Other - Org Name:PREFERRED HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-481-9625
Mailing Address - Street 1:1220 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-4827
Mailing Address - Country:US
Mailing Address - Phone:573-481-9625
Mailing Address - Fax:573-481-9639
Practice Address - Street 1:301 SOVEREIGN COURT
Practice Address - Street 2:SUITE 206
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4435
Practice Address - Country:US
Practice Address - Phone:636-527-9330
Practice Address - Fax:636-527-9340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146-HO251G00000X
MO144-3HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO826224107Medicaid
MO1821025826Medicaid
MO1821025826Medicaid