Healthcare Provider Details

I. General information

NPI: 1881906824
Provider Name (Legal Business Name): WISE CHOICE INHOME SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9953 LEWIS AND CLARK BLVD STE 203
SAINT LOUIS MO
63136-5307
US

IV. Provider business mailing address

9953 LEWIS AND CLARK BLVD STE 203
SAINT LOUIS MO
63136-5307
US

V. Phone/Fax

Practice location:
  • Phone: 314-868-9900
  • Fax: 314-868-9902
Mailing address:
  • Phone: 314-868-9900
  • Fax: 314-868-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. NICOLE BAILEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 314-646-9997