Healthcare Provider Details

I. General information

NPI: 1184011520
Provider Name (Legal Business Name): HORAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BRENTWOOD BLVD STE. 835
SAINT LOUIS MO
63144-1416
US

IV. Provider business mailing address

1401 S, BRENTWOOD BLVD STE. 835
SAINT LOUIS MO
63144
US

V. Phone/Fax

Practice location:
  • Phone: 314-503-6158
  • Fax:
Mailing address:
  • Phone: 314-503-6158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberR9455
License Number StateMO

VIII. Authorized Official

Name: DR. DAVID WILLIAM HORAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-503-6158