MEDICARE: COMPLETE HOMECARE MISSOURI 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1184348716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE HOMECARE MISSOURI LLC

Provider Business Mailing Address
First Line	:	3029 DONNYCAVE LN
Second Line	:
City	:	MARYLAND HTS
State	:	MO
Zip	:	63043-1318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3029 DONNYCAVE LN
Second Line	:
City	:	MARYLAND HTS
State	:	MO
Zip	:	63043-1318
Country	:	US
Telephone Number	:	917-847-0810
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VIKRAM KAUL
Credential	:
Telephone Number	:	917-847-0810

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	09/29/2022

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