Healthcare Provider Details

I. General information

NPI: 1225842784
Provider Name (Legal Business Name): FULL CARE LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9799 SAINT CHARLES LANE UNIT B
SAINT ANN MO
63074
US

IV. Provider business mailing address

9799 SAINT CHARLES LANE UNIT B
SAINT ANN MO
63074-1138
US

V. Phone/Fax

Practice location:
  • Phone: 314-804-2246
  • Fax:
Mailing address:
  • Phone: 314-804-2246
  • 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: TRACI BROWN
Title or Position: OWNER
Credential:
Phone: 314-804-2246