=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154241735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOUNTIFUL BENEVOLENCE IN HOME SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2026
-----------------------------------------------------
Last Update Date | 07/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 MID RIVERS MALL DR STE B2
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-2171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-395-2361
-----------------------------------------------------
Fax | 363-538-7008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 MID RIVERS MALL DR STE B2
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-2171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-395-2361
-----------------------------------------------------
Fax | 363-538-7008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | TYREN COTTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 636-395-2361
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------