Healthcare Provider Details

I. General information

NPI: 1043827272
Provider Name (Legal Business Name): ADRIAN C GILLARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10253 CEDARHURST DR
SAINT LOUIS MO
63136-5615
US

IV. Provider business mailing address

10253 CEDARHURST DR
SAINT LOUIS MO
63136-5615
US

V. Phone/Fax

Practice location:
  • Phone: 314-624-8761
  • Fax:
Mailing address:
  • Phone: 314-624-8761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: