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General NPI Number Information
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NPI Number | 1184497968
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Entity Type | Organization
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Legal Business Name | BOUNTIFUL BENEVOLENCE AT HOME WE CARE
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 1000 MID RIVERS MALL DR STE B2
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City | SAINT PETERS
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State | MO
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Zip | 63376-2171
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Country | US
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Telephone | 636-395-2361
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Fax |
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Provider Business Mailing Address
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Address Line | 500 ARBOR LANE DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-7682
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Country | US
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Telephone | 636-395-2361
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. TYREN COTTON
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Credential | CPC
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Telephone | 636-395-2361
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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 |
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License Number State |
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