Provider Demographics
NPI:1245276781
Name:COMMUNITY LOVING CARE HOSPICE, L.L.C.
Entity type:Organization
Organization Name:COMMUNITY LOVING CARE HOSPICE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:DANDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-639-6280
Mailing Address - Street 1:251 E PEARCE BLVD
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-1529
Mailing Address - Country:US
Mailing Address - Phone:636-639-6280
Mailing Address - Fax:636-639-6317
Practice Address - Street 1:251 E PEARCE BLVD
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1529
Practice Address - Country:US
Practice Address - Phone:636-639-6280
Practice Address - Fax:636-639-6317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26-1594Medicare ID - Type UnspecifiedPROVIDER NUMBER