Healthcare Provider Details

I. General information

NPI: 1063693604
Provider Name (Legal Business Name): ELANTIS IN-HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 GOLDEN DR
SAINT LOUIS MO
63137-1553
US

IV. Provider business mailing address

1423 GOLDEN DR
SAINT LOUIS MO
63137-1553
US

V. Phone/Fax

Practice location:
  • Phone: 314-388-9570
  • Fax: 314-388-1421
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LANECIA DENISE MOORE
Title or Position: ADMINISTRATOR
Credential:
Phone: 314-388-9570