Healthcare Provider Details

I. General information

NPI: 1235515602
Provider Name (Legal Business Name): MISSOUR HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 W FLORISSANT AVE
SAINT LOUIS MO
63136-1424
US

IV. Provider business mailing address

1675 TURF LN
FLORISSANT MO
63033-2343
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 Number363LF0000X
License Number StateMO

VIII. Authorized Official

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