MEDICARE: CAREQOR WELLNESS, 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	251B00000X	Case Management Agency
2	251J00000X	Nursing Care Agency	899542	MS
3	291U00000X	Clinical Medical Laboratory
4	385H00000X	Respite Care
5	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1568828341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREQOR WELLNESS, LLC

Provider Business Mailing Address
First Line	:	720 OLIVE ST APT 2104
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63101-2302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 TRACE COLONY PARK DR
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-8810
Country	:	US
Telephone Number	:	314-399-8622
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	KAY WILLIAMS
Credential	:
Telephone Number	:	314-399-8622

Provider Enumeration Date	:	01/08/2016
Last Update Date	:	08/08/2024

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