Healthcare Provider Details

I. General information

NPI: 1013731942
Provider Name (Legal Business Name): SURE HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 GRAVOIS AVE UNIT 1F
SAINT LOUIS MO
63116-4656
US

IV. Provider business mailing address

3800 GRAVOIS AVE UNIT 1F
SAINT LOUIS MO
63116-4656
US

V. Phone/Fax

Practice location:
  • Phone: 314-537-1357
  • Fax:
Mailing address:
  • Phone: 314-537-1357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion 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: SHAKARRA LEAK THOMPSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-537-1357