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General NPI Number Information
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NPI Number | 1417627001
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Entity Type | Organization
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Legal Business Name | LIFE FORWARD HOME HEALTH SERVICES LLC
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 2055 CRAIGSHIRE RD STE 410D
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4036
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Country | US
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Telephone | 314-485-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 2055 CRAIGSHIRE RD STE 410D
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4036
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | VICTORIA MONTGOMERY
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Credential |
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Telephone | 314-485-1515
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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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