MEDICARE: JOURNEY 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	251E00000X	Home Health Agency		MO

General Provider Information

NPI Number	:	1124563150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY HOME CARE LLC

Provider Business Mailing Address
First Line	:	8420 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2816
Country	:	US
Telephone Number	:	314-695-5324
Fax Number	:	314-395-8431

Provider Business Practice Location Address
First Line	:	8420 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2816
Country	:	US
Telephone Number	:	314-695-5324
Fax Number	:	314-395-8431

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JUNE WALKER
Credential	:
Telephone Number	:	314-496-2763

Provider Enumeration Date	:	12/29/2016
Last Update Date	:	07/21/2022

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