Healthcare Provider Details

I. General information

NPI: 1427224658
Provider Name (Legal Business Name): ELDERCARE PROFESSIONAL IN HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3642 BOTANICAL AVE
SAINT LOUIS MO
63110-4002
US

IV. Provider business mailing address

3642 BOTANICAL AVE
SAINT LOUIS MO
63110-4002
US

V. Phone/Fax

Practice location:
  • Phone: 314-664-8616
  • Fax:
Mailing address:
  • Phone: 314-664-8616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. ALFRED BLAKEMORE
Title or Position: PRESIDENT
Credential:
Phone: 314-664-8616