=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437695889
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ULTIMATE CARE HEALTH SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1322 LEROY AVE
-----------------------------------------------------
City | ST. LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-571-9742
-----------------------------------------------------
Fax | 314-827-0049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1322 LEROY AVE
-----------------------------------------------------
City | ST. LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-571-9742
-----------------------------------------------------
Fax | 314-827-0049
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | TERRIKAH COOK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-600-8879
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------