Provider Demographics
NPI:1003845298
Name:FAIRHOPE HOSPICE & PALLIATIVE CARE INC
Entity type:Organization
Organization Name:FAIRHOPE HOSPICE & PALLIATIVE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLASURE
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:740-654-7077
Mailing Address - Street 1:282 SELLS RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3461
Mailing Address - Country:US
Mailing Address - Phone:740-654-7077
Mailing Address - Fax:740-654-0376
Practice Address - Street 1:282 SELLS ROAD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4056
Practice Address - Country:US
Practice Address - Phone:740-654-7077
Practice Address - Fax:740-654-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0820160Medicaid
OH0820160Medicaid