Healthcare Provider Details

I. General information

NPI: 1497075691
Provider Name (Legal Business Name): MARTHA'S HANDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11906 MANCHESTER RD SUITE 204
SAINT LOUIS MO
63131-4503
US

IV. Provider business mailing address

11906 MANCHESTER RD SUITE 204
SAINT LOUIS MO
63131-4503
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-4350
  • Fax: 314-965-0123
Mailing address:
  • Phone: 314-965-4350
  • Fax: 314-965-0123

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 State

VIII. Authorized Official

Name: ANDREW JOHN HUBER
Title or Position: GENERAL MANAGER
Credential:
Phone: 314-965-4350