Healthcare Provider Details

I. General information

NPI: 1114364684
Provider Name (Legal Business Name): MISSOURI HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 W FLORISSANT AVE SUITE 200
SAINT LOUIS MO
63136-1424
US

IV. Provider business mailing address

9191 W FLORISSANT AVE SUITE 200
SAINT LOUIS MO
63136-1424
US

V. Phone/Fax

Practice location:
  • Phone: 314-524-3958
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number267655
License Number StateMO

VIII. Authorized Official

Name: DIONNESHAE FORLAND
Title or Position: OWNER
Credential:
Phone: 314-524-3958