Healthcare Provider Details

I. General information

NPI: 1528746831
Provider Name (Legal Business Name): COHAP CHILDREN, ADULT & SENIOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 WESTPORT COVE LN SUITE B
SAINT LOUIS MO
63146-6424
US

IV. Provider business mailing address

1611 WESTPORT COVE LN APT B
SAINT LOUIS MO
63146-6424
US

V. Phone/Fax

Practice location:
  • Phone: 314-566-5154
  • Fax:
Mailing address:
  • Phone: 314-566-5154
  • Fax:

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BERACE BENNETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-566-5154