Healthcare Provider Details

I. General information

NPI: 1922646728
Provider Name (Legal Business Name): EDUHEALTH PERSONAL CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 11/27/2023
Certification Date: 05/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5843 EAGLE VALLEY DR SAINT LOUIS MO 63136
SAINT LOUIS MO
63136
US

IV. Provider business mailing address

5843 EAGLE VALLEY DR SAINT LOUIS MO 63136
SAINT LOUIS MO
63136
US

V. Phone/Fax

Practice location:
  • Phone: 314-371-7717
  • Fax:
Mailing address:
  • Phone: 314-371-7717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: TINNYAH BRANDON
Title or Position: MANAGER
Credential:
Phone: 314-371-7717