=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154719847
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HELPING HANDS HOMECARE AND PRIVATE DUTY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2015
-----------------------------------------------------
Last Update Date | 01/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 W PORT PLZ
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63146-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-542-3089
-----------------------------------------------------
Fax | 314-542-3111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 W PORT PLZ
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63146-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-542-3089
-----------------------------------------------------
Fax | 314-542-3111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. SHARLA MONIQUE RENEE WALKER
-----------------------------------------------------
Credential | RN, BSN
-----------------------------------------------------
Telephone | 314-556-0376
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------