Provider Demographics
NPI:1669413555
Name:BEACON OF HOPE HOSPICE, INC.
Entity type:Organization
Organization Name:BEACON OF HOPE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-815-3500
Mailing Address - Street 1:1318 RAVENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5447
Mailing Address - Country:US
Mailing Address - Phone:319-234-4673
Mailing Address - Fax:563-391-5104
Practice Address - Street 1:1318 RAVENWOOD RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5447
Practice Address - Country:US
Practice Address - Phone:319-234-4673
Practice Address - Fax:563-391-5104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA161579Medicare Oscar/Certification