Healthcare Provider Details

I. General information

NPI: 1063926558
Provider Name (Legal Business Name): MAXCO HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4144 LINDELL BLVD STE 219
SAINT LOUIS MO
63108-2932
US

IV. Provider business mailing address

4144 LINDELL BLVD STE 219
SAINT LOUIS MO
63108-2932
US

V. Phone/Fax

Practice location:
  • Phone: 314-267-0363
  • Fax: 314-261-9515
Mailing address:
  • Phone: 314-267-0363
  • Fax: 314-261-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. SHARONA MCCLENDON
Title or Position: DIRECTOR/CEO
Credential:
Phone: 314-267-0363