MEDICARE: AUTUMN DAY HOME HEALTHCARE 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	:	1841816154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTUMN DAY HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	9241 HARNELL DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63137-1710
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9241 HARNELL DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63137-1710
Country	:	US
Telephone Number	:	314-412-4032
Fax Number	:

Authorized Official
Title or Position	:	CDS COORDINATOR
Name	:	KAYLA JOHNSON
Credential	:
Telephone Number	:	314-412-4032

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	06/23/2020

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