=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164856332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSURED HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2013
-----------------------------------------------------
Last Update Date | 03/31/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8639 JENNINGS STATION RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63136-6305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-669-9766
-----------------------------------------------------
Fax | 314-405-8186
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8639 JENNINGS STATION RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63136-6305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-669-9766
-----------------------------------------------------
Fax | 314-405-8186
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | TARIA K DYSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-599-6594
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------