=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730753377
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARING MOMENTS IN-HOME HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2021
-----------------------------------------------------
Last Update Date | 05/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12064 WENSLEY RD
-----------------------------------------------------
City | BLACK JACK
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63033-7322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-620-5553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 424
-----------------------------------------------------
City | FLORISSANT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63032-0424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-620-5553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | EBONY BOWERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-614-7648
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------