Healthcare Provider Details

I. General information

NPI: 1487333555
Provider Name (Legal Business Name): LILLIAN FOLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4649 GRINSTEAD CT APT 4
SAINT LOUIS MO
63121-2236
US

IV. Provider business mailing address

4649 GRINSTEAD CT APT 4
SAINT LOUIS MO
63121-2236
US

V. Phone/Fax

Practice location:
  • Phone: 314-566-7402
  • Fax:
Mailing address:
  • Phone: 314-566-7402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberE171113006
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: