Healthcare Provider Details

I. General information

NPI: 1588942866
Provider Name (Legal Business Name): HOME ASSIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 STAG INDUSTRIAL BLVD
LAKE ST LOUIS MO
63367-4240
US

IV. Provider business mailing address

105 STAG INDUSTRIAL BLVD
LAKE ST LOUIS MO
63367-4240
US

V. Phone/Fax

Practice location:
  • Phone: 636-695-5801
  • Fax: 636-561-7930
Mailing address:
  • Phone: 636-695-5801
  • Fax: 636-561-7930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number863-HH
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SCOTT A SEABAUGH
Title or Position: VP/ADMINISTRATOR
Credential: MBA
Phone: 636-695-5524