Healthcare Provider Details

I. General information

NPI: 1053364992
Provider Name (Legal Business Name): IN HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12101 WOODCREST EXECUTIVE DR
SAINT LOUIS MO
63141-5047
US

IV. Provider business mailing address

333 N SUMMIT ST ATTN DEAN SHIPMAN
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 314-453-0990
  • Fax: 314-453-0290
Mailing address:
  • Phone: 419-254-7841
  • Fax: 419-252-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number714-6
License Number StateMO

VIII. Authorized Official

Name: MR. BARRY A LAZARUS
Title or Position: VICE PRESIDENT - REIMBURSEMENTS
Credential:
Phone: 419-252-5541