Healthcare Provider Details

I. General information

NPI: 1871321257
Provider Name (Legal Business Name): EXPRESS HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 OAKDALE AVE
SAINT LOUIS MO
63121-5437
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 TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

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