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General NPI Number Information
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NPI Number | 1558815894
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Entity Type | Organization
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Legal Business Name | SACRED HEART CONSUMER DIRECTED SERVICES
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 2013 HOMEFIELD RIDGE DR
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City | O FALLON
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State | MO
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Zip | 63366-4752
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Country | US
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Telephone | 314-839-3359
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Fax |
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Provider Business Mailing Address
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Address Line | 2013 HOMEFIELD RIDGE DR
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City | O FALLON
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State | MO
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Zip | 63366-4752
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Country | US
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Telephone | 314-839-3359
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LATINA BERRYHILL
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Credential |
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Telephone | 314-445-4247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 16-000066
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 16-000066
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License Number State | MO
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