Provider Demographics
NPI:1184739245
Name:CROWN HOSPICE INC
Entity type:Organization
Organization Name:CROWN HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-492-6440
Mailing Address - Street 1:2858 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5035
Mailing Address - Country:US
Mailing Address - Phone:573-335-4800
Mailing Address - Fax:573-335-4805
Practice Address - Street 1:2858 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5035
Practice Address - Country:US
Practice Address - Phone:573-335-4800
Practice Address - Fax:573-335-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO826299406Medicaid