Healthcare Provider Details

I. General information

NPI: 1003313990
Provider Name (Legal Business Name): PLAZA HEALTHCARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 FOX CHASE DR
SAINT CHARLES MO
63301-8370
US

IV. Provider business mailing address

320 BROOKES DR. SUITE 200
HAZELWOOD MO
63301
US

V. Phone/Fax

Practice location:
  • Phone: 314-761-8628
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DENISE JARVIS
Title or Position: OWNER
Credential:
Phone: 314-761-8628