Healthcare Provider Details

I. General information

NPI: 1457134124
Provider Name (Legal Business Name): WOEZOR HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9944 W FLORISSANT AVE
SAINT LOUIS MO
63136-1432
US

IV. Provider business mailing address

9944 W FLORISSANT AVE
SAINT LOUIS MO
63136-1432
US

V. Phone/Fax

Practice location:
  • Phone: 314-868-1733
  • Fax: 314-338-3660
Mailing address:
  • Phone: 314-868-1733
  • Fax: 314-338-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: REBECCA MAWUENYEGA
Title or Position: OWNER/MANAGER
Credential:
Phone: 314-868-1733