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General NPI Number Information
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NPI Number | 1245083054
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Entity Type | Organization
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Legal Business Name | SANTOS HOME HEALTHCARE
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 12406 LUSHER RD
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City | SAINT LOUIS
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State | MO
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Zip | 63138-1456
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Country | US
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Telephone | 314-455-9471
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Fax | 314-455-9470
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Provider Business Mailing Address
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Address Line | 12406 LUSHER RD
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City | SAINT LOUIS
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State | MO
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Zip | 63138-1456
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Country | US
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Telephone | 314-455-9471
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Fax | 314-455-9470
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DEMARCO H BOYD
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Credential | DR
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Telephone | 314-455-9471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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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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