Healthcare Provider Details

I. General information

NPI: 1700304409
Provider Name (Legal Business Name): LISA R. BURNETT DBA LRB HOME HEALTH CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 EMINENCE AVE
SAINT LOUIS MO
63134-3420
US

IV. Provider business mailing address

320 BROOKES DRIVE SUITE 102
ST. LOUIS MO
63134
US

V. Phone/Fax

Practice location:
  • Phone: 314-363-1853
  • Fax:
Mailing address:
  • Phone: 314-363-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberLC9821011
License Number StateMO

VIII. Authorized Official

Name: MRS. LISA RENEE BURNETT
Title or Position: OWNER
Credential:
Phone: 314-363-1853