Healthcare Provider Details

I. General information

NPI: 1710124870
Provider Name (Legal Business Name): FACTS OF LIFE IN HOME SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S MAIN ST STE 204
SAINT CHARLES MO
63301-3306
US

IV. Provider business mailing address

820 S MAIN ST STE 204
SAINT CHARLES MO
63301-3306
US

V. Phone/Fax

Practice location:
  • Phone: 636-925-0202
  • Fax: 636-925-0117
Mailing address:
  • Phone: 636-925-0202
  • Fax: 636-925-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA HARRIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 636-925-0202