Healthcare Provider Details

I. General information

NPI: 1215320684
Provider Name (Legal Business Name): SINGLE SOURCE FOR SENIORS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5572 CLEMENS PL SUITE 2E
SAINT LOUIS MO
63112-3059
US

IV. Provider business mailing address

PO BOX 150447
SAINT LOUIS MO
63115-8447
US

V. Phone/Fax

Practice location:
  • Phone: 770-280-5597
  • Fax:
Mailing address:
  • Phone: 770-280-5597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHERYL DEAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 770-280-5597