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General NPI Number Information
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NPI Number | 1114204781
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Entity Type | Organization
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Legal Business Name | ALICE HOME HEALTH CARE, LLC
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 8420 DELMAR BLVD STE LL4
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City | SAINT LOUIS
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State | MO
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Zip | 63124-2176
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Country | US
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Telephone | 314-872-1700
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Fax | 314-872-1810
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Provider Business Mailing Address
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Address Line | 8420 DELMAR BLVD, STE LL4
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City | SAINT LOUIS
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State | MO
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Zip | 63124
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Country | US
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Telephone | 314-872-1700
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Fax | 314-872-1810
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | YELENA V DAVYDENKO
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Credential |
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Telephone | 314-872-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | LC1132839
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License Number State | MO
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