MEDICARE: CHARISE THOMAS

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	LC001549753	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

General Provider Information

NPI Number	:	1407371750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARISE THOMAS

Provider Business Mailing Address
First Line	:	5056A MARDEL AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1730
Country	:	US
Telephone Number	:	314-262-1476
Fax Number	:

Provider Business Practice Location Address
First Line	:	5056A MARDEL AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1730
Country	:	US
Telephone Number	:	314-262-1476
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	07/21/2022

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Directions to “ CHARISE THOMAS ” Practice Location

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