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General NPI Number Information
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NPI Number | 1225992092
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Entity Type | Organization
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Legal Business Name | FV AT HOME - SUPPORTIVE SERVICES, LLC
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 12563 VILLAGE CIRCLE DRIVE
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City | ST. LOUIS
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State | MO
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Zip | 63127
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Country | US
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Telephone | 314-270-7318
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Fax | 314-525-7500
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Provider Business Mailing Address
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Address Line | 12563 VILLAGE CIRCLE DRIVE
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City | ST. LOUIS
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State | MO
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Zip | 63127-1758
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Country | US
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Telephone | 314-270-7318
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Fax | 314-525-7500
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Authorized Official
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Title or Position | DIRECTOR, CORPORATE ADMINISTRATION
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Name | SUE CHAMPION
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Credential |
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Telephone | 314-270-7810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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