=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851808257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING STREAMS HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2018
-----------------------------------------------------
Last Update Date | 01/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4255 GREENSBORO DR
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63304-1612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-629-4782
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4255 GREENSBORO DR
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63304-1612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-629-4782
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS DIRECTOR
-----------------------------------------------------
Name | MR. PETER KARANJA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-629-4782
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------