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General NPI Number Information
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NPI Number | 1649651472
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Entity Type | Organization
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Legal Business Name | OUR KINGS AND QUEENS HOME HEALTH LLC
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 100 S 4TH ST SUITE 550
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City | SAINT LOUIS
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State | MO
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Zip | 63102-1800
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Country | US
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Telephone | 314-224-5544
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Fax | 314-797-5001
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Provider Business Mailing Address
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Address Line | 100 S 4TH ST SUITE 550
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City | SAINT LOUIS
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State | MO
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Zip | 63102-1800
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Country | US
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Telephone | 314-797-5033
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Fax | 314-797-5001
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/OWNER
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Name | JAOHN COOPER SHAMEEKA COOPER
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Credential |
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Telephone | 314-709-6861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | LC9782201
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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 |
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License Number State | MO
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