Provider Demographics
NPI:1588923759
Name:COMFORT HOSPICE OF MISSOURI, LLC
Entity type:Organization
Organization Name:COMFORT HOSPICE OF MISSOURI, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-824-6609
Mailing Address - Street 1:P.O. BOX 99278
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-9278
Mailing Address - Country:US
Mailing Address - Phone:248-824-6000
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:8706 MANCHESTER RD
Practice Address - Street 2:STE 102
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-2733
Practice Address - Country:US
Practice Address - Phone:314-266-0950
Practice Address - Fax:855-845-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1588923759Medicaid
MO213-6HOOtherSTATE OF MISSOURI HOSPICE LICENSE