Healthcare Provider Details

I. General information

NPI: 1508290958
Provider Name (Legal Business Name): LIFE CHANGING HOME HEALTH & ADULT DAY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 JUNGERMANN RD
SAINT PETERS MO
63376-1608
US

IV. Provider business mailing address

104 JUNGERMANN RD
SAINT PETERS MO
63376-1608
US

V. Phone/Fax

Practice location:
  • Phone: 636-279-4663
  • Fax: 636-279-4663
Mailing address:
  • Phone: 636-279-4663
  • Fax: 636-279-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1095
License Number StateMO

VIII. Authorized Official

Name: MRS. DOROTHY THOMAS
Title or Position: PRESIDENT
Credential:
Phone: 636-279-4663