Healthcare Provider Details

I. General information

NPI: 1922789775
Provider Name (Legal Business Name): EXCLUSIVE CARE IN HOME HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5916 NATURAL BRIDGE AVE
SAINT LOUIS MO
63120-1436
US

IV. Provider business mailing address

5916 NATURAL BRIDGE AVE
SAINT LOUIS MO
63120-1436
US

V. Phone/Fax

Practice location:
  • Phone: 314-704-6192
  • Fax: 314-312-6420
Mailing address:
  • Phone: 314-704-6192
  • Fax: 314-312-6420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE TRINA FOXWORTH
Title or Position: DIRECTOR
Credential:
Phone: 314-874-3004