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General NPI Number Information
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NPI Number | 1700259264
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Entity Type | Organization
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Legal Business Name | PROVISION HOME CARE INC
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 9378 OLIVE BLVD SUITE #215
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City | OLIVETTE
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State | MO
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Zip | 63132-3215
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Country | US
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Telephone | 314-569-4121
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Fax |
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Provider Business Mailing Address
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Address Line | 9378 OLIVE BLVD SUITE #215
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City | OLIVETTE
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State | MO
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Zip | 63132-3215
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Country | US
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Telephone | 314-569-4121
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/MANAGER
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Name | DR. EMMANUEL B OPOKU
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Credential | PHARM.D.
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Telephone | 314-569-4121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | SSBG/GR0008084
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | SSBG/GR0008084
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | SSBG/GR0008084
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License Number State | MO
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