Healthcare Provider Details

I. General information

NPI: 1124945365
Provider Name (Legal Business Name): STAY AT HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29954 BAHNER QUARRY RD
TIPTON MO
65081-3317
US

IV. Provider business mailing address

29954 BAHNER QUARRY RD
TIPTON MO
65081-3317
US

V. Phone/Fax

Practice location:
  • Phone: 573-353-1292
  • Fax:
Mailing address:
  • Phone: 573-353-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. HOLLY MARIE JACKSON
Title or Position: OWNER
Credential:
Phone: 573-353-1292