Healthcare Provider Details

I. General information

NPI: 1861255275
Provider Name (Legal Business Name): 1111 HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 UNION BLVD # 207
SAINT LOUIS MO
63108-1040
US

IV. Provider business mailing address

826 UNION BLVD # 207
SAINT LOUIS MO
63108-1040
US

V. Phone/Fax

Practice location:
  • Phone: 314-884-8447
  • Fax:
Mailing address:
  • Phone: 314-412-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TANESHIA R DILWORTH
Title or Position: CEO
Credential:
Phone: 314-884-8447