MEDICARE: ELANTIS IN-HOME HEALTH 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1063693604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELANTIS IN-HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	1423 GOLDEN DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63137-1553
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1423 GOLDEN DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63137-1553
Country	:	US
Telephone Number	:	314-388-9570
Fax Number	:	314-388-1421

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. LANECIA DENISE MOORE
Credential	:
Telephone Number	:	314-388-9570

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	11/26/2007

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