=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275069270
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOAHIL HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2017
-----------------------------------------------------
Last Update Date | 05/11/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4432 FARLIN AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63115-2723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-745-0005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 1ST CAPITOL DR STE 2
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63301-2898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-493-6261
-----------------------------------------------------
Fax | 636-493-6850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOT/OWNER
-----------------------------------------------------
Name | BRANDY FOWLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-745-0005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------