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General NPI Number Information
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NPI Number | 1366216897
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Entity Type | Organization
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Legal Business Name | MRS OCTAVIA HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 11/23/2023
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Provider Practice Location Address
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Address Line | 1516 GOODFELLOW BLVD UNIT-A 1516 GOODFELLOW BLVD APT-A
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City | SAINT LOUIS
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State | MO
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Zip | 63112
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Country | US
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Telephone | 314-226-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 1516 GOODFELLOW BLVD UNIT-A 1516 GOODFELLOW BLVD UNIT-A
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City | SAINT LOUIS
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State | MO
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Zip | 63112
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Country | US
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Telephone | 314-652-4209
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEBRA EDWARDS
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Credential |
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Telephone | 314-226-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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