=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619611159
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELCHS HOME HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2022
-----------------------------------------------------
Last Update Date | 04/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1204 MEAD DR
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63137-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-943-8585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1204 MEAD DR
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63137-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-943-8585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DESIGNATED MANAGER/OWNER
-----------------------------------------------------
Name | AERIONE WELCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-943-8585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------