Provider Demographics
NPI:1912174327
Name:THREE RIVERS HOSPICE INC
Entity Type:Organization
Organization Name:THREE RIVERS HOSPICE INC
Other - Org Name:THREE RIVERS HOSPICE WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHIRRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1276
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:731 N MAIN ST
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-2151
Mailing Address - Country:US
Mailing Address - Phone:573-471-1276
Mailing Address - Fax:573-472-8504
Practice Address - Street 1:631 N SPRING PARK BLVD
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712
Practice Address - Country:US
Practice Address - Phone:417-461-0580
Practice Address - Fax:417-461-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO198-6HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based