MEDICARE: WILLIAM'S HOME

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	:	1093319758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM'S HOME

Provider Business Mailing Address
First Line	:	5470 ORIOLE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120-2412
Country	:	US
Telephone Number	:	314-203-4439
Fax Number	:

Provider Business Practice Location Address
First Line	:	5470 ORIOLE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120-2412
Country	:	US
Telephone Number	:	314-203-4439
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LASHELL JONES
Credential	:
Telephone Number	:	314-203-4439

Provider Enumeration Date	:	11/24/2020
Last Update Date	:	11/24/2020

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Directions to “WILLIAM'S HOME ” Practice Location

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