Healthcare Provider Details

I. General information

NPI: 1558015552
Provider Name (Legal Business Name): AMITY AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 LINDELL BLVD SUITE 208
ST. LOUIS MO
63108
US

IV. Provider business mailing address

P.O. BOX 300502
ST. LOUIS MO
63130
US

V. Phone/Fax

Practice location:
  • Phone: 314-329-7744
  • Fax:
Mailing address:
  • Phone: 314-599-3652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KISHA JACKSON
Title or Position: DIRECTOR
Credential:
Phone: 314-329-7744