Healthcare Provider Details

I. General information

NPI: 1033671417
Provider Name (Legal Business Name): 1 CALL AWAY IN-HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 LOVE DR
O FALLON MO
63366-1739
US

IV. Provider business mailing address

808 LOVE DR
O FALLON MO
63366-1739
US

V. Phone/Fax

Practice location:
  • Phone: 314-250-0018
  • Fax:
Mailing address:
  • Phone: 314-250-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. ROBBREKA EBONY GREEN
Title or Position: MANAGER
Credential:
Phone: 314-250-0018