Healthcare Provider Details

I. General information

NPI: 1831500768
Provider Name (Legal Business Name): DELIVERED VISION HOME HEALTH SVC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N EUCLID AVE STE 322
SAINT LOUIS MO
63108-1660
US

IV. Provider business mailing address

4144 LINDELL BLVD STE 511
ST. LOUIS MO
63108
US

V. Phone/Fax

Practice location:
  • Phone: 314-300-8104
  • Fax: 314-300-8114
Mailing address:
  • Phone: 314-300-8104
  • Fax: 314-300-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberLC9734256
License Number StateMO

VIII. Authorized Official

Name: MRS. SHANTA KANICA MORRIS
Title or Position: OWNER
Credential:
Phone: 314-300-8104