Healthcare Provider Details

I. General information

NPI: 1942716428
Provider Name (Legal Business Name): UNDER GRACE HOME HEALTH AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7847 DARTMOOR DR
SAINT LOUIS MO
63121-1323
US

IV. Provider business mailing address

7847 DARTMOOR DR
SAINT LOUIS MO
63121-1323
US

V. Phone/Fax

Practice location:
  • Phone: 314-518-7227
  • Fax:
Mailing address:
  • Phone:
  • 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: TASHAUNA PARKER
Title or Position: OWNER
Credential:
Phone: 314-518-7227