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General NPI Number Information
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NPI Number | 1073057592
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Entity Type | Organization
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Legal Business Name | FAMILY 1ST HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 3410 CARRIAGE XING
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City | SAINT CHARLES
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State | MO
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Zip | 63301-3225
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Country | US
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Telephone | 618-567-1277
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Fax |
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Provider Business Mailing Address
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Address Line | 180 SMOLA LN
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City | GLEN CARBON
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State | IL
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Zip | 62034-1365
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Country | US
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Telephone | 618-567-1277
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRACEY BERRY
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Credential |
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Telephone | 618-567-1277
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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 |
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License Number State |
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