Healthcare Provider Details

I. General information

NPI: 1144898032
Provider Name (Legal Business Name): FSH-IN HOME HEALTH CARE,LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/13/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 FRONT ST
TROY MO
63379-1306
US

IV. Provider business mailing address

251 FRONT ST
TROY MO
63379-1306
US

V. Phone/Fax

Practice location:
  • Phone: 636-290-1532
  • Fax:
Mailing address:
  • Phone: 636-290-5105
  • Fax: 636-528-1855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA ELISE PULLIAM
Title or Position: MANAGER
Credential:
Phone: 636-290-5105