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General NPI Number Information
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NPI Number | 1417558412
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Entity Type | Organization
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Legal Business Name | AVI MARIE VITALITY HOME CARE LLC
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 7777 BONHOMME AVE STE 1827
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City | SAINT LOUIS
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State | MO
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Zip | 63105-1911
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Country | US
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Telephone | 314-764-5020
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Fax | 636-237-8304
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Provider Business Mailing Address
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Address Line | 7777 BONHOMME STE #1827 8321 MCLARAN AVE
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City | ST LOUIS
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State | MO
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Zip | 63136-1129
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Country | US
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Telephone | 314-764-5020
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Fax | 636-237-8304
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Authorized Official
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Title or Position | OWNER
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Name | MELODY TAREKA MOORE
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Credential |
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Telephone | 770-596-8919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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