Healthcare Provider Details

I. General information

NPI: 1891705547
Provider Name (Legal Business Name): BJC HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8573
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 314-953-1615
  • Fax: 314-273-0704
Mailing address:
  • Phone: 314-953-1615
  • Fax: 314-273-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number00010918
License Number StateMO

VIII. Authorized Official

Name: ANGELA MARTIN-DAVIS
Title or Position: PRESIDENT
Credential:
Phone: 314-206-3712