Healthcare Provider Details

I. General information

NPI: 1144998014
Provider Name (Legal Business Name): MERCY & MIRACLE HEALTH SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 WALTON RD STE 202
OVERLAND MO
63114-5805
US

IV. Provider business mailing address

514 EARTH CITY PLZ STE 312
EARTH CITY MO
63045-1303
US

V. Phone/Fax

Practice location:
  • Phone: 314-300-9095
  • Fax: 314-492-0196
Mailing address:
  • Phone: 314-222-8130
  • Fax: 314-492-0196

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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDRA JOHNSON
Title or Position: OWNER
Credential: DM PHD
Phone: 314-401-8028