=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295720118
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELMAR GARDENS HOME CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2005
-----------------------------------------------------
Last Update Date | 01/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14805 N OUTER 40 RD SUITE 320
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-6060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-733-7330
-----------------------------------------------------
Fax | 636-733-7340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14805 N OUTER 40 RD SUITE 300
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-6060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-733-7000
-----------------------------------------------------
Fax | 636-733-7010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | BRYAN BACKOWSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 636-733-7330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 493-19HH
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------