Healthcare Provider Details

I. General information

NPI: 1619233384
Provider Name (Legal Business Name): KMEENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2012
Last Update Date: 04/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WASHINGTON AVE
SAINT LOUIS MO
63101-1263
US

IV. Provider business mailing address

1000 WASHINGTON AVE
SAINT LOUIS MO
63101-1263
US

V. Phone/Fax

Practice location:
  • Phone: 314-337-3490
  • Fax:
Mailing address:
  • Phone: 314-337-3490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHY M EVANS
Title or Position: OWNER
Credential:
Phone: 314-337-3490