Healthcare Provider Details

I. General information

NPI: 1396694279
Provider Name (Legal Business Name): CERTIFIED IN HOME CARE IL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2026
Last Update Date: 01/24/2026
Certification Date: 01/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MCKELVEY RD STE 203
BRIDGETON MO
63044-4073
US

IV. Provider business mailing address

3801 MCKELVEY RD STE 203
BRIDGETON MO
63044-4073
US

V. Phone/Fax

Practice location:
  • Phone: 314-541-0448
  • Fax: 314-475-5605
Mailing address:
  • Phone: 314-541-0448
  • Fax: 314-475-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: VALERIE D STEWART
Title or Position: OWNER
Credential: STEWART
Phone: 314-541-0448