=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497562078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IN GOOD HANDS CDS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2024
-----------------------------------------------------
Last Update Date | 12/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12891 PENNRIDGE DR STE 140
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63044-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-495-0589
-----------------------------------------------------
Fax | 314-736-1058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12891 PENNRIDGE DR STE 140
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63044-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-495-0589
-----------------------------------------------------
Fax | 314-736-1058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | HOLLY WIGGINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-495-0589
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------