=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588274872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRIFFIN HOME HEALTHCARE, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2020
-----------------------------------------------------
Last Update Date | 08/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4537 LOUISIANA AVE # 2B
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63111-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-354-6595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4537 LOUISIANA AVE # 2B
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63111-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-354-6595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MISS LAKESHA LANAY GRIFFIN
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 314-229-5529
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------