Healthcare Provider Details

I. General information

NPI: 1053430090
Provider Name (Legal Business Name): MDS IN-HOME SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8519 DRURY LN
SAINT LOUIS MO
63147-1313
US

IV. Provider business mailing address

8519 DRURY LN
SAINT LOUIS MO
63147-1313
US

V. Phone/Fax

Practice location:
  • Phone: 314-385-2275
  • Fax: 314-385-2275
Mailing address:
  • Phone: 314-385-2275
  • Fax: 314-385-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARILYN DIXSON
Title or Position: MANAGER
Credential:
Phone: 314-385-2275