Provider Demographics
NPI:1245319367
Name:UNITY HOSPICE OF GREATER ST LOUIS LLC
Entity type:Organization
Organization Name:UNITY HOSPICE OF GREATER ST LOUIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-982-1800
Mailing Address - Street 1:4101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2753
Mailing Address - Country:US
Mailing Address - Phone:847-982-1800
Mailing Address - Fax:847-982-1801
Practice Address - Street 1:1604 EASTPORT PLAZA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-6133
Practice Address - Country:US
Practice Address - Phone:618-346-1111
Practice Address - Fax:618-346-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2002533251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid