Healthcare Provider Details

I. General information

NPI: 1831771690
Provider Name (Legal Business Name): DYNASTY HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/24/2021
Certification Date: 04/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 PURE ST
SAINT PETERS MO
63376-3484
US

IV. Provider business mailing address

2101 PURE ST
SAINT PETERS MO
63376-3484
US

V. Phone/Fax

Practice location:
  • Phone: 636-442-3194
  • Fax:
Mailing address:
  • Phone: 636-442-3194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALLANTE NICOLE HENDERSON
Title or Position: MANAGER
Credential:
Phone: 636-442-3194