=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780431759
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORPINE HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2024
-----------------------------------------------------
Last Update Date | 05/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3324 RUE ROYALE ST STE 104
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63301-8321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-498-0517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3324 RUE ROYALE ST STE 104
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63301-8321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-498-0517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MIA PARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-498-0517
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------