MEDICARE: OH SO GOOD HOME HEALTH CARE, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1245636109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OH SO GOOD HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	923 IRON ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63111-2645
Country	:	US
Telephone Number	:	314-341-5481
Fax Number	:	314-932-5696

Provider Business Practice Location Address
First Line	:	11116 S TOWNE SQ
Second Line	:	SUITE 104
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7809
Country	:	US
Telephone Number	:	314-436-9941
Fax Number	:	314-932-5696

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MS. LASHONDA Q LEWIS
Credential	:
Telephone Number	:	314-341-5481

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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