Healthcare Provider Details

I. General information

NPI: 1992935712
Provider Name (Legal Business Name): LIFECARE MISSOURI INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 S. MASON ROAD SUITE 204
ST. LOUIS MO
63131
US

IV. Provider business mailing address

2190 S. MASON ROAD SUITE 204
ST. LOUIS MO
63131
US

V. Phone/Fax

Practice location:
  • Phone: 314-984-8650
  • Fax: 314-909-1033
Mailing address:
  • Phone: 314-984-8650
  • Fax: 314-909-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number835-HH
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number835-HH
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number835-HH
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number835-HH
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES E. SCARLETT
Title or Position: OWNER
Credential:
Phone: 630-697-8844