Healthcare Provider Details

I. General information

NPI: 1659541274
Provider Name (Legal Business Name): EXPRESS HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 OAKDALE AVE
SAINT LOUIS MO
63121
US

IV. Provider business mailing address

3641 OAKDALE AVE
SAINT LOUIS MO
63121-5437
US

V. Phone/Fax

Practice location:
  • Phone: 314-727-0453
  • Fax: 314-727-6067
Mailing address:
  • Phone: 314-727-0453
  • Fax: 314-727-6067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: DIANE SHELTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 314-727-0453