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General NPI Number Information
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NPI Number | 1821927401
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Entity Type | Organization
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Legal Business Name | MERCHANT COLLECTIVE HEALTHCARE LLC
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Dates
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Enumeration Date | 05/18/2026
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Last Update Date | 05/18/2026
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Provider Practice Location Address
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Address Line | 6212 TIMBERWOLFE DR
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City | GLEN CARBON
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State | IL
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Zip | 62034-1388
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Country | US
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Telephone | 314-365-4738
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 41
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City | GLEN CARBON
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State | IL
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Zip | 62034-0041
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Country | US
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Telephone | 314-365-4738
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Fax |
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Authorized Official
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Title or Position | OWNER/ DIRECTOR OF CLINICAL OPERATI
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Name | VIRGINIA GENTRY
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Credential | BSN, RN
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Telephone | 314-365-4738
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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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