MEDICARE: CRITERION IN-HOME HEALTH SERVICE , 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1336489145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRITERION IN-HOME HEALTH SERVICE , LLC

Provider Business Mailing Address
First Line	:	10270 PAGE AVE STE A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-1322
Country	:	US
Telephone Number	:	314-219-4173
Fax Number	:	314-584-7028

Provider Business Practice Location Address
First Line	:	10270 PAGE AVE STE A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-1322
Country	:	US
Telephone Number	:	314-219-4173
Fax Number	:	314-584-7028

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DONNA BECTON
Credential	:
Telephone Number	:	314-219-4173

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	02/15/2013

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