Healthcare Provider Details

I. General information

NPI: 1386502722
Provider Name (Legal Business Name): WONDERFUL CARE HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 S HANLEY RD APT C
SAINT LOUIS MO
63105-2665
US

IV. Provider business mailing address

923 S HANLEY RD APT C
SAINT LOUIS MO
63105-2665
US

V. Phone/Fax

Practice location:
  • Phone: 314-386-0577
  • Fax:
Mailing address:
  • Phone: 314-386-0577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY PARTEE
Title or Position: MANAGER
Credential:
Phone: 314-386-0577