MEDICARE: PHASES OF CARE IN-HOME SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1023680337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHASES OF CARE IN-HOME SERVICES, LLC

Provider Business Mailing Address
First Line	:	100 RUE SAINT FRANCOIS ST STE 106
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-5131
Country	:	US
Telephone Number	:	314-489-9674
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 RUE SAINT FRANCOIS ST STE 106
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-5131
Country	:	US
Telephone Number	:	314-489-9674
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. TIERA PAGE
Credential	:
Telephone Number	:	314-489-9674

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	07/15/2021

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