Healthcare Provider Details

I. General information

NPI: 1255530465
Provider Name (Legal Business Name): AT EASE HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 OLIVE BLVD SUITE 176
SAINT LOUIS MO
63141-7143
US

IV. Provider business mailing address

11500 OLIVE BLVD SUITE 176
SAINT LOUIS MO
63141-7143
US

V. Phone/Fax

Practice location:
  • Phone: 314-531-5310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number00478801
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number00478801
License Number StateMO

VIII. Authorized Official

Name: DAN FRIEDMAN
Title or Position: OFFICER
Credential:
Phone: 314-351-3510