Healthcare Provider Details

I. General information

NPI: 1447286554
Provider Name (Legal Business Name): TEAM SELECT HOME CARE OF MISSOURI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12125 WOODCREST EXECUTIVE DR STE 200
SAINT LOUIS MO
63141-5015
US

IV. Provider business mailing address

2999 N 44TH ST STE 100
PHOENIX AZ
85018-7247
US

V. Phone/Fax

Practice location:
  • Phone: 314-669-8997
  • Fax: 314-669-8998
Mailing address:
  • Phone: 602-382-8500
  • Fax: 602-253-5656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number893-HH
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LOVELL
Title or Position: VICE PRESIDENT
Credential:
Phone: 480-618-5760