Healthcare Provider Details

I. General information

NPI: 1366093767
Provider Name (Legal Business Name): CERTIFIED IN HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12163 BRIDGETON SQUARE DR
BRIDGETON MO
63044-2616
US

IV. Provider business mailing address

12163 BRIDGETON SQUARE DR
BRIDGETON MO
63044-2616
US

V. Phone/Fax

Practice location:
  • Phone: 314-541-0448
  • Fax: 636-757-3428
Mailing address:
  • Phone: 314-541-0448
  • Fax: 318-726-8530

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