Healthcare Provider Details

I. General information

NPI: 1811409253
Provider Name (Legal Business Name): OUTREACH HOME HEALTHCARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10351 CAPITOL DR
SAINT LOUIS MO
63136-4305
US

IV. Provider business mailing address

10351 CAPITOL DR
SAINT LOUIS MO
63136-4305
US

V. Phone/Fax

Practice location:
  • Phone: 314-504-6240
  • Fax: 314-867-2133
Mailing address:
  • Phone: 314-504-6240
  • 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 Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: LAYA TURNER
Title or Position: OWNER
Credential:
Phone: 314-504-6240