MEDICARE: UNIVERSAL PLUS HOMECARE AGENCY 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1770818908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL PLUS HOMECARE AGENCY LLC

Provider Business Mailing Address
First Line	:	3106 PEARL HARBOR DR
Second Line	:
City	:	ST. ANN
State	:	MO
Zip	:	63074
Country	:	US
Telephone Number	:	314-423-7900
Fax Number	:	314-423-7902

Provider Business Practice Location Address
First Line	:	3106 PEARL HARBOR DR
Second Line	:
City	:	SAINT ANN
State	:	MO
Zip	:	63074-3809
Country	:	US
Telephone Number	:	314-423-7900
Fax Number	:	314-423-7902

Authorized Official
Title or Position	:	CEO
Name	:	MR. GERRY L ANDERSON SR.
Credential	:
Telephone Number	:	314-423-7900

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	10/06/2009

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