Provider Demographics
NPI:1952306714
Name:SAFE HARBOR HOSPICE, INC.
Entity Type:Organization
Organization Name:SAFE HARBOR HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:AYYAGARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-760-8899
Mailing Address - Street 1:206 HYLER DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-2985
Mailing Address - Country:US
Mailing Address - Phone:573-760-8899
Mailing Address - Fax:573-760-1412
Practice Address - Street 1:206 HYLER DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2985
Practice Address - Country:US
Practice Address - Phone:573-760-8899
Practice Address - Fax:573-760-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1074HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO261586Medicare ID - Type UnspecifiedPROVIDER NUMBER