Healthcare Provider Details

I. General information

NPI: 1538072137
Provider Name (Legal Business Name): K B HOME HEALTH CARE IHS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 WOODSON RD STE 108
SAINT LOUIS MO
63134-3701
US

IV. Provider business mailing address

4411 WOODSON RD STE 108
SAINT LOUIS MO
63134-3701
US

V. Phone/Fax

Practice location:
  • Phone: 314-473-1036
  • Fax: 314-473-1045
Mailing address:
  • Phone: 314-473-1036
  • Fax: 314-473-1045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DEWAYNE MARBLEY
Title or Position: OWNER
Credential:
Phone: 314-473-1036