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General NPI Number Information
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NPI Number | 1306974233
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Entity Type | Organization
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Legal Business Name | SSM HOME CARE PRIVATE DUTY
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 4385 MARYLAND AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2703
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Country | US
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Telephone | 314-533-4107
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Fax | 314-533-0058
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Provider Business Mailing Address
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Address Line | 10143 PAGET DR
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City | SAINT LOUIS
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State | MO
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Zip | 63132-2915
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Country | US
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Telephone | 314-989-2524
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Fax | 314-989-3901
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. MIKE TOPOLSKI
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Credential |
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Telephone | 314-989-2528
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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 | NA
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License Number State |
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