Healthcare Provider Details

I. General information

NPI: 1689004673
Provider Name (Legal Business Name): ADDITIONAL IN HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S WOODLAWN STE. 27
O FALLON MO
63366-7646
US

IV. Provider business mailing address

801 WOODLAWN AVE STE 29
O FALLON MO
63366-7647
US

V. Phone/Fax

Practice location:
  • Phone: 636-294-6324
  • Fax: 866-277-3475
Mailing address:
  • Phone: 636-294-6324
  • Fax: 636-294-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. CRYSTAL LYNN DANIELS
Title or Position: PRESIDENT
Credential:
Phone: 314-497-5990