Healthcare Provider Details

I. General information

NPI: 1245083054
Provider Name (Legal Business Name): SANTOS HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12406 LUSHER RD
SAINT LOUIS MO
63138-1456
US

IV. Provider business mailing address

12406 LUSHER RD
SAINT LOUIS MO
63138-1456
US

V. Phone/Fax

Practice location:
  • Phone: 314-455-9471
  • Fax: 314-455-9470
Mailing address:
  • Phone: 314-455-9471
  • Fax: 314-455-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DEMARCO H BOYD
Title or Position: EXECUTIVE DIRECTOR
Credential: DR
Phone: 314-455-9471