Healthcare Provider Details

I. General information

NPI: 1013860592
Provider Name (Legal Business Name): DAISYS HEART HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13043 MYSTIC BEND LN
BLACK JACK MO
63033-4563
US

IV. Provider business mailing address

13043 MYSTIC BEND LN
BLACK JACK MO
63033-4563
US

V. Phone/Fax

Practice location:
  • Phone: 314-813-4095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAWANA HARRIS
Title or Position: MANAGER
Credential:
Phone: 314-813-4095