Healthcare Provider Details

I. General information

NPI: 1093794141
Provider Name (Legal Business Name): BABY BOOMERS HOME HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15332 MANCHESTER RD SUITE 201
ELLISVILLE MO
63011-3072
US

IV. Provider business mailing address

15332 MANCHESTER RD SUITE 201
ELLISVILLE MO
63011-3072
US

V. Phone/Fax

Practice location:
  • Phone: 636-391-5353
  • Fax: 636-391-8051
Mailing address:
  • Phone: 636-391-5353
  • Fax: 636-391-8051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number778
License Number StateMO

VIII. Authorized Official

Name: MISS TINA L KUEHL
Title or Position: ADMINISTRATOR
Credential:
Phone: 636-391-5353