MEDICARE: MOTIVATE HEALTHCARE IN-HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	153557	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033566427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTIVATE HEALTHCARE IN-HOME LLC

Provider Business Mailing Address
First Line	:	315 LEMAY FERRY RD
Second Line	:	SUITE 135
City	:	LEMAY
State	:	MO
Zip	:	63125-1501
Country	:	US
Telephone Number	:	314-669-9760
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 LEMAY FERRY RD
Second Line	:	SUITE 135
City	:	LEMAY
State	:	MO
Zip	:	63125-1501
Country	:	US
Telephone Number	:	314-669-9760
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TAMEKA SCOTT
Credential	:
Telephone Number	:	314-580-4233

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	05/16/2016

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