=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043663784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACTS OF CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2016
-----------------------------------------------------
Last Update Date | 09/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6618 BOLES AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63121-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-517-3337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6618 BOLES AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63121-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-517-3337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MIRIAM HARRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-517-3337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | LC001473531
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------