Healthcare Provider Details

I. General information

NPI: 1326939869
Provider Name (Legal Business Name): XTREME HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2025
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 S 5TH ST STE 77
SAINT CHARLES MO
63301-2484
US

IV. Provider business mailing address

1360 S 5TH ST STE 77
SAINT CHARLES MO
63301-2484
US

V. Phone/Fax

Practice location:
  • Phone: 314-224-4702
  • Fax:
Mailing address:
  • Phone: 314-224-4702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANNON WHITFIELD
Title or Position: MANAGER
Credential:
Phone: 314-224-4702