Healthcare Provider Details

I. General information

NPI: 1700478476
Provider Name (Legal Business Name): EVERYBODYS HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WEST RAILROAD STREET
GIDEON MO
63848-6384
US

IV. Provider business mailing address

PO BOX 355
GIDEON MO
63848-0355
US

V. Phone/Fax

Practice location:
  • Phone: 573-313-0300
  • Fax:
Mailing address:
  • Phone: 573-313-0300
  • Fax:

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: MR. KIP DWAYNE WHITE
Title or Position: OWNER/PARTNER
Credential:
Phone: 573-313-0300