Healthcare Provider Details

I. General information

NPI: 1225992092
Provider Name (Legal Business Name): FV AT HOME - SUPPORTIVE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12563 VILLAGE CIRCLE DRIVE
ST. LOUIS MO
63127
US

IV. Provider business mailing address

12563 VILLAGE CIRCLE DRIVE
ST. LOUIS MO
63127-1758
US

V. Phone/Fax

Practice location:
  • Phone: 314-270-7318
  • Fax: 314-525-7500
Mailing address:
  • Phone: 314-270-7318
  • Fax: 314-525-7500

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: SUE CHAMPION
Title or Position: DIRECTOR, CORPORATE ADMINISTRATION
Credential:
Phone: 314-270-7810