Healthcare Provider Details

I. General information

NPI: 1265702526
Provider Name (Legal Business Name): THE HEART OF DAVID IN-HOME SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3236 LIBERTY ST
SAINT LOUIS MO
63111-1701
US

IV. Provider business mailing address

3236 LIBERTY ST
SAINT LOUIS MO
63111-1701
US

V. Phone/Fax

Practice location:
  • Phone: 314-932-9848
  • Fax: 314-832-5159
Mailing address:
  • Phone: 314-932-9848
  • Fax: 314-832-5159

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMO

VIII. Authorized Official

Name: MS. DONNA K BRYANT
Title or Position: DIRECTOR
Credential:
Phone: 314-308-4590