Healthcare Provider Details

I. General information

NPI: 1184557530
Provider Name (Legal Business Name): CERTIFIED IN HOME CARE IL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12163 BRIDGETON SQUARE DR OFC A
BRIDGETON MO
63044-2616
US

IV. Provider business mailing address

12163 BRIDGETON SQUARE DR OFC A
BRIDGETON MO
63044-2616
US

V. Phone/Fax

Practice location:
  • Phone: 314-541-0448
  • Fax: 318-726-8530
Mailing address:
  • Phone: 314-541-0448
  • Fax: 318-726-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

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