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General NPI Number Information
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NPI Number | 1366991473
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Entity Type | Organization
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Legal Business Name | AT EAZE HOME HEALTH LLC
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Dates
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Enumeration Date | 09/30/2016
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Last Update Date | 09/30/2016
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Provider Practice Location Address
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Address Line | 11941 SAN ANDRES DR
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City | SAINT LOUIS
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State | MO
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Zip | 63138-3649
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Country | US
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Telephone | 314-322-9083
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 N WARSON RD SUITE 127
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City | SAINT LOUIS
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State | MO
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Zip | 63132-1111
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Country | US
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Telephone | 314-736-1102
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIONNE L RANDLE
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Credential |
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Telephone | 314-322-9083
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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 |
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License Number State |
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