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General NPI Number Information
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NPI Number | 1144667403
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Entity Type | Organization
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Legal Business Name | ODESSA'S LOVE & CARE
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 6326 GARFIELD AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63134-1708
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Country | US
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Telephone | 314-757-6941
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Fax |
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Provider Business Mailing Address
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Address Line | 6326 GARFIELD AVE PO BOX 5849
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City | SAINT LOUIS
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State | MO
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Zip | 63134-1708
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CMT
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Name | MRS. ROBIN SHERELL JONES
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Credential |
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Telephone | 314-757-6941
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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 | 1312151
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License Number State | MO
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