Healthcare Provider Details

I. General information

NPI: 1588927842
Provider Name (Legal Business Name): CARE4AGES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8936 MAYFIELD CT
SAINT LOUIS MO
63136-5054
US

IV. Provider business mailing address

8936 MAYFIELD CT
SAINT LOUIS MO
63136-5054
US

V. Phone/Fax

Practice location:
  • Phone: 314-629-1136
  • Fax:
Mailing address:
  • Phone: 314-629-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: LATISHIA PORTER
Title or Position: MANAGER
Credential:
Phone: 314-629-1136