Healthcare Provider Details

I. General information

NPI: 1578084208
Provider Name (Legal Business Name): LRB HOME HEALTH CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 EMINENCE AVE
SAINT LOUIS MO
63134-3420
US

IV. Provider business mailing address

4400 EMINENCE AVE
SAINT LOUIS MO
63134-3420
US

V. Phone/Fax

Practice location:
  • Phone: 314-363-1853
  • Fax: 314-363-1853
Mailing address:
  • Phone: 314-363-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberLC9821011
License Number StateMO

VIII. Authorized Official

Name: MRS. LISA BURNETT
Title or Position: OWNER
Credential:
Phone: 314-363-1853