Provider Demographics
NPI:1538537816
Name:BREEZE HOSPICE OF MISSOURI, LLC
Entity type:Organization
Organization Name:BREEZE HOSPICE OF MISSOURI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KULSOOM
Authorized Official - Middle Name:FATIMA
Authorized Official - Last Name:JUNAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-922-2662
Mailing Address - Street 1:3535 S JEFFERSON AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3930
Mailing Address - Country:US
Mailing Address - Phone:314-833-3180
Mailing Address - Fax:314-833-3179
Practice Address - Street 1:3535 S JEFFERSON AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3930
Practice Address - Country:US
Practice Address - Phone:314-833-3180
Practice Address - Fax:314-833-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO244-HOOtherSTATE LICENCE