=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851757538
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORGET ME NOT IN HOME HEALTH CARE LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2016
-----------------------------------------------------
Last Update Date | 01/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3910 S OLD HIGHWAY 94 SUITE 109
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63304-2834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-498-3237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3910 S OLD HIGHWAY 94 SUITE 109
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63304-2834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-498-3237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/OWNER
-----------------------------------------------------
Name | ROSHANDA A GRIFFIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-498-3237
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305S00000X
-----------------------------------------------------
Taxonomy Name | Point of Service
-----------------------------------------------------
License Number | 22654356
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------