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General NPI Number Information
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NPI Number | 1467964577
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Entity Type | Organization
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Legal Business Name | FAMILY OF PRIDE HOME HEALTH SERVICES LLC
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 10/30/2017
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Provider Practice Location Address
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Address Line | 4552 ADELAIDE AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63115-3031
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Country | US
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Telephone | 314-718-3436
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Fax | 314-932-5200
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Provider Business Mailing Address
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Address Line | 4552 ADELAIDE AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63115-3031
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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 | MANAGER
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Name | ROBYN LOVE-CLARKE
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Credential |
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Telephone | 314-718-3436
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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 | LC001450728
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License Number State | MO
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