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General NPI Number Information
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NPI Number | 1720300346
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Entity Type | Organization
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Legal Business Name | DIVERSE HEALTH SERVICES LLC
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 4200 UNION BLVD SUITE 110
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City | SAINT LOUIS
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State | MO
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Zip | 63115-1227
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Country | US
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Telephone | 314-667-5951
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Fax |
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Provider Business Mailing Address
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Address Line | 3620 N SPRING AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63107-2220
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Country | US
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Telephone | 314-667-5951
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. LAVINCENT HOOKER
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Credential |
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Telephone | 314-667-5951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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 |
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