Healthcare Provider Details

I. General information

NPI: 1467042184
Provider Name (Legal Business Name): HOME CARE MO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 05/29/2025
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4179 CRESCENT DRIVE SUITE A
ST. LOUIS MO
63129
US

IV. Provider business mailing address

4179 CRESCENT DRIVE SUITE A
ST. LOUIS MO
63129
US

V. Phone/Fax

Practice location:
  • Phone: 314-501-5330
  • Fax: 314-530-5400
Mailing address:
  • Phone: 314-501-5330
  • Fax: 314-530-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PINNY FASKA
Title or Position: CEO
Credential:
Phone: 314-501-5330