Healthcare Provider Details

I. General information

NPI: 1821927401
Provider Name (Legal Business Name): MERCHANT COLLECTIVE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6212 TIMBERWOLFE DR
GLEN CARBON IL
62034-1388
US

IV. Provider business mailing address

PO BOX 41
GLEN CARBON IL
62034-0041
US

V. Phone/Fax

Practice location:
  • Phone: 314-365-4738
  • Fax:
Mailing address:
  • Phone: 314-365-4738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA GENTRY
Title or Position: OWNER/ DIRECTOR OF CLINICAL OPERATI
Credential: BSN, RN
Phone: 314-365-4738