MEDICARE: SACRED HEART HOME HEALTH/MEDICAL SUPPLY SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251F00000X	Home Infusion Agency
3	251J00000X	Nursing Care Agency
4	253Z00000X	In Home Supportive Care Agency
5	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1518267749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED HEART HOME HEALTH/MEDICAL SUPPLY SERVICES

Provider Business Mailing Address
First Line	:	17656 GARDENVIEW MANOR CIR
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63038-1496
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17656 GARDENVIEW MANOR CIR
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63038-1496
Country	:	US
Telephone Number	:	314-503-1442
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. LUKA IJEI
Credential	:	MBA
Telephone Number	:	314-503-1442

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	10/21/2010

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