MEDICARE: ALGONQUIN NURSES HOME HEALTH CARE I, 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		MO
2	253Z00000X	In Home Supportive Care Agency		MO

General Provider Information

NPI Number	:	1083166516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALGONQUIN NURSES HOME HEALTH CARE I, LLC

Provider Business Mailing Address
First Line	:	10135 MANCHESTER RD
Second Line	:	SUITE 102
City	:	ST LOUIS
State	:	MO
Zip	:	63122-1559
Country	:	US
Telephone Number	:	314-822-8158
Fax Number	:	314-822-0952

Provider Business Practice Location Address
First Line	:	10135 MANCHESTER RD
Second Line	:	SUITE 102
City	:	ST LOUIS
State	:	MO
Zip	:	63122-1559
Country	:	US
Telephone Number	:	314-822-8158
Fax Number	:	314-822-0952

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEPHEN ANTHONY TAMBOLI
Credential	:
Telephone Number	:	314-822-8158

Provider Enumeration Date	:	11/01/2016
Last Update Date	:	12/27/2024

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