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General NPI Number Information
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NPI Number | 1518267749
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Entity Type | Organization
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Legal Business Name | SACRED HEART HOME HEALTH/MEDICAL SUPPLY SERVICES
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 17656 GARDENVIEW MANOR CIR
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City | WILDWOOD
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State | MO
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Zip | 63038-1496
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Country | US
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Telephone | 314-503-1442
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Fax |
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Provider Business Mailing Address
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Address Line | 17656 GARDENVIEW MANOR CIR
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City | WILDWOOD
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State | MO
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Zip | 63038-1496
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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 | PRESIDENT/CEO
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Name | MR. LUKA IJEI
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Credential | MBA
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Telephone | 314-503-1442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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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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