Healthcare Provider Details

I. General information

NPI: 1003799057
Provider Name (Legal Business Name): POWER UP HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4887 BESSIE AVE
SAINT LOUIS MO
63115-2143
US

IV. Provider business mailing address

4887 BESSIE AVE
SAINT LOUIS MO
63115-2143
US

V. Phone/Fax

Practice location:
  • Phone: 314-435-9625
  • Fax:
Mailing address:
  • Phone: 314-435-9625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNETTA POOL
Title or Position: MEMBER /MANAGER
Credential:
Phone: 314-435-9625