Healthcare Provider Details

I. General information

NPI: 1811549322
Provider Name (Legal Business Name): ALLEGIANCE HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 PLYMOUTH AVE STE W116
SAINT LOUIS MO
63133-1905
US

IV. Provider business mailing address

6439 PLYMOUTH AVE STE W116
SAINT LOUIS MO
63133-1905
US

V. Phone/Fax

Practice location:
  • Phone: 314-341-0915
  • Fax: 314-696-8302
Mailing address:
  • Phone: 314-341-0915
  • Fax: 314-696-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARSHA MITCHELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-341-0915