=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902467046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXUS HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2019
-----------------------------------------------------
Last Update Date | 06/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1451 MULLANPHY ST STE 108
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63106-3114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-660-2890
-----------------------------------------------------
Fax | 314-225-0597
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4224 W SAN FRANCISCO AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63115-2917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-660-2890
-----------------------------------------------------
Fax | 314-225-0597
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. SYLVESTER L WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-660-2890
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------