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General NPI Number Information
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NPI Number | 1013120096
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Entity Type | Organization
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Legal Business Name | JENN-CARE HOME NURSINGS & SERVICES INC
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 6104 WYMA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63120-1331
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Country | US
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Telephone | 314-381-0930
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Fax | 314-381-1216
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Provider Business Mailing Address
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Address Line | 6104 WYMA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63120-1331
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Country | US
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Telephone | 314-381-0930
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Fax | 314-381-1216
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. FAIRESTENE JENNINGS
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Credential |
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Telephone | 314-381-0930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 060824
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License Number State | MO
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