Healthcare Provider Details

I. General information

NPI: 1962350462
Provider Name (Legal Business Name): MOMENTUM HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7128 PENNSYLVANIA AVE
SAINT LOUIS MO
63111-3137
US

IV. Provider business mailing address

7128 PENNSYLVANIA AVE
SAINT LOUIS MO
63111-3137
US

V. Phone/Fax

Practice location:
  • Phone: 314-243-9406
  • Fax: 314-243-9406
Mailing address:
  • Phone: 314-243-9406
  • Fax: 314-243-9406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARAYH TAYLOR
Title or Position: DIRECTOR
Credential:
Phone: 314-243-9406