Healthcare Provider Details

I. General information

NPI: 1346221272
Provider Name (Legal Business Name): VICTOR'S HOME CARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 DELMAR BLVD SUITE 507
SAINT LOUIS MO
63124-2170
US

IV. Provider business mailing address

8420 DELMAR BLVD SUITE 507
SAINT LOUIS MO
63124-2170
US

V. Phone/Fax

Practice location:
  • Phone: 314-872-8844
  • Fax:
Mailing address:
  • Phone: 314-872-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number8001344
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0006871
License Number StateMO

VIII. Authorized Official

Name: MR. VICTOR BARINGOLTS
Title or Position: PRESIDENT
Credential:
Phone: 314-872-8844