Healthcare Provider Details

I. General information

NPI: 1073699732
Provider Name (Legal Business Name): PRIVATE NURSING SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9713 GRAVOIS RD
ST. LOUIS MO
63123-4346
US

IV. Provider business mailing address

9713 GRAVOIS RD.
ST. LOUIS MO
63123-4346
US

V. Phone/Fax

Practice location:
  • Phone: 314-544-2020
  • Fax: 314-544-2645
Mailing address:
  • Phone: 314-544-2020
  • Fax: 314-544-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMO

VIII. Authorized Official

Name: PAMELA SUE HICKS
Title or Position: PRESIDENT
Credential:
Phone: 314-544-2020