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General NPI Number Information
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NPI Number | 1588349245
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Entity Type | Organization
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Legal Business Name | MRS OCTAVIA INHOME HEALTH CARE SERVICE
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 1516 GOODFELLOW BLVD APT A1516
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City | SAINT LOUIS
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State | MO
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Zip | 63112-3828
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Country | US
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Telephone | 314-652-4209
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Fax | 314-226-4500
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Provider Business Mailing Address
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Address Line | 1516 GOODFELLOW BLVD APT A
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City | SAINT LOUIS
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State | MO
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Zip | 63112-3828
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Country | US
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Telephone | 314-260-9106
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Fax | 557-467-2616
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Authorized Official
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Title or Position | OWNER
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Name | DEBRA EDWARDS
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Credential |
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Telephone | 314-260-9106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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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 | 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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