Healthcare Provider Details

I. General information

NPI: 1346884558
Provider Name (Legal Business Name): CONCIERGE HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8016 KNIGHTS CROSSING DR
O FALLON MO
63368-6208
US

IV. Provider business mailing address

8016 KNIGHTS CROSSING DR
O FALLON MO
63368-6208
US

V. Phone/Fax

Practice location:
  • Phone: 314-200-4071
  • Fax: 314-200-4059
Mailing address:
  • Phone: 314-200-4071
  • Fax: 314-200-4059

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GINA LANIER
Title or Position: PRESIDENT
Credential:
Phone: 314-200-4071