Healthcare Provider Details

I. General information

NPI: 1285094763
Provider Name (Legal Business Name): HOME4LIFE HOME CARE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10716 NEW HALLS FERRY RD
SAINT LOUIS MO
63136-4431
US

IV. Provider business mailing address

10716 NEW HALLS FERRY RD
SAINT LOUIS MO
63136-4431
US

V. Phone/Fax

Practice location:
  • Phone: 314-797-8598
  • Fax: 314-797-8008
Mailing address:
  • Phone: 314-797-8598
  • Fax: 314-797-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number0016986
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number0016986
License Number StateMO

VIII. Authorized Official

Name: AIGNER MILES
Title or Position: OWNER
Credential:
Phone: 314-797-8598