Provider Demographics
NPI:1891700720
Name:FAMILY HOSPICE OF BELLEVILLE AREA
Entity Type:Organization
Organization Name:FAMILY HOSPICE OF BELLEVILLE AREA
Other - Org Name:FAMILY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:618-277-1800
Mailing Address - Street 1:5110 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-4729
Mailing Address - Country:US
Mailing Address - Phone:618-277-1800
Mailing Address - Fax:618-277-1074
Practice Address - Street 1:5110 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-4729
Practice Address - Country:US
Practice Address - Phone:618-277-1800
Practice Address - Fax:618-277-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2001089251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid