Healthcare Provider Details

I. General information

NPI: 1497429377
Provider Name (Legal Business Name): HEALTH AT HOME II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 WASHINGTON AVE
SAINT LOUIS MO
63103-1905
US

IV. Provider business mailing address

3859 FOLSOM AVE
SAINT LOUIS MO
63110-2611
US

V. Phone/Fax

Practice location:
  • Phone: 314-662-0253
  • Fax:
Mailing address:
  • Phone: 314-662-0253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PERNELL KENYATTE BEASLEY
Title or Position: OWNER
Credential:
Phone: 314-662-0253