MEDICARE: AWESOME 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1609133990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWESOME CARE LLC

Provider Business Mailing Address
First Line	:	1360 S 5TH ST STE 346
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2447
Country	:	US
Telephone Number	:	314-686-0234
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 S 5TH ST STE 346
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2447
Country	:	US
Telephone Number	:	314-686-0234
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. BRITTNEY DENISE DICKINSON
Credential	:
Telephone Number	:	314-686-0234

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	04/12/2012

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