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General NPI Number Information
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NPI Number | 1992783732
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HOME HEALTH AGENCY LLC
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 03/28/2014
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Provider Practice Location Address
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Address Line | 2730 S SAINT PETERS PKWY SUITE 300
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City | SAINT PETERS
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State | MO
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Zip | 63303-5677
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Country | US
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Telephone | 636-946-5051
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Fax | 636-946-5039
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Provider Business Mailing Address
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Address Line | 2730 S SAINT PETERS PKWY SUITE 300
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City | SAINT PETERS
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State | MO
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Zip | 63303-5677
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Country | US
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Telephone | 636-946-5051
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Fax | 636-946-5039
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Authorized Official
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Title or Position | CEO
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Name | MALIK S KARIM
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Credential |
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Telephone | 636-946-5051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 267593
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License Number State | MO
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