Healthcare Provider Details

I. General information

NPI: 1396347167
Provider Name (Legal Business Name): INNOVATIVE HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 NECTAR DR
SAINT LOUIS MO
63137-2225
US

IV. Provider business mailing address

1169 NECTAR DR
SAINT LOUIS MO
63137-2225
US

V. Phone/Fax

Practice location:
  • Phone: 314-918-5391
  • Fax: 314-328-6224
Mailing address:
  • Phone: 314-918-5391
  • Fax: 314-328-6224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STACY R MITCHELL
Title or Position: OWNER
Credential:
Phone: 314-918-5391