Healthcare Provider Details

I. General information

NPI: 1033450077
Provider Name (Legal Business Name): MERCY VISIONS HOME HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 DOMAIN ST APT 1
SAINT CHARLES MO
63301-8301
US

IV. Provider business mailing address

3221 DOMAIN ST APT 1
SAINT CHARLES MO
63301-8301
US

V. Phone/Fax

Practice location:
  • Phone: 636-294-5089
  • Fax: 636-614-0766
Mailing address:
  • Phone: 636-294-5089
  • Fax: 636-614-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMO

VIII. Authorized Official

Name: MS. TERRELL LYNN SIMMS
Title or Position: PRESIDENT
Credential:
Phone: 636-294-5089