Healthcare Provider Details

I. General information

NPI: 1699845610
Provider Name (Legal Business Name): HOME CARE NURSING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 DELASSUS RD
FARMINGTON MO
63640-7001
US

IV. Provider business mailing address

3370 DELASSUS RD
FARMINGTON MO
63640-7001
US

V. Phone/Fax

Practice location:
  • Phone: 573-747-1678
  • Fax: 573-747-0583
Mailing address:
  • Phone: 573-747-1678
  • Fax: 573-747-0583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number005434
License Number StateMO

VIII. Authorized Official

Name: SUSAN LEA STOTZ
Title or Position: PRESIDENT
Credential: RN
Phone: 573-747-1678