Healthcare Provider Details

I. General information

NPI: 1780431759
Provider Name (Legal Business Name): ORPINE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3324 RUE ROYALE ST STE 104
SAINT CHARLES MO
63301-8321
US

IV. Provider business mailing address

3324 RUE ROYALE ST STE 104
SAINT CHARLES MO
63301-8321
US

V. Phone/Fax

Practice location:
  • Phone: 314-498-0517
  • Fax:
Mailing address:
  • Phone: 314-498-0517
  • 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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MIA PARK
Title or Position: DIRECTOR
Credential:
Phone: 314-498-0517