MEDICARE: HEALTHLINE IN-HOME CARE, 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	251J00000X	Nursing Care Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1043634306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHLINE IN-HOME CARE, LLC

Provider Business Mailing Address
First Line	:	9715 OLIVE BLVD STE C
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-3004
Country	:	US
Telephone Number	:	636-386-8323
Fax Number	:	314-755-1030

Provider Business Practice Location Address
First Line	:	9715 OLIVE BLVD STE C
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-3004
Country	:	US
Telephone Number	:	636-386-8323
Fax Number	:	314-755-1030

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL SHENDEROV
Credential	:
Telephone Number	:	636-675-0946

Provider Enumeration Date	:	02/06/2014
Last Update Date	:	08/03/2023

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