Healthcare Provider Details

I. General information

NPI: 1215241500
Provider Name (Legal Business Name): KNOWING GENERATIONS HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GIMLIN PL
SAINT LOUIS MO
63138-1503
US

IV. Provider business mailing address

5 GIMLIN PL
SAINT LOUIS MO
63138-1503
US

V. Phone/Fax

Practice location:
  • Phone: 314-246-0035
  • Fax:
Mailing address:
  • Phone: 314-246-0035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA T JACKSON
Title or Position: OWNER/DESIGNATED MANAGER
Credential:
Phone: 314-246-0035