Healthcare Provider Details

I. General information

NPI: 1740655398
Provider Name (Legal Business Name): DIVERSIFIED HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WESTPORT PLAZA STE. 600
ST. LOUIS MO
63146
US

IV. Provider business mailing address

111 WESTPORT PLAZA STE. 600
ST. LOUIS MO
63146
US

V. Phone/Fax

Practice location:
  • Phone: 314-363-4532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MS. NINA KEY
Title or Position: MANAGER
Credential:
Phone: 314-363-4532