Healthcare Provider Details

I. General information

NPI: 1013032671
Provider Name (Legal Business Name): SPECIALTY IN HOME SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 MALLORY RD
DEXTER MO
63841-2768
US

IV. Provider business mailing address

914 MALLORY RD
DEXTER MO
63841-2768
US

V. Phone/Fax

Practice location:
  • Phone: 573-624-9925
  • Fax: 573-624-9928
Mailing address:
  • Phone: 573-624-9925
  • Fax: 573-624-9928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHASTITY ANN COURTER
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 573-624-9925