MEDICARE: BOUNTIFUL HARVEST HOME HEALTHCARE

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	:	1205444254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOUNTIFUL HARVEST HOME HEALTHCARE

Provider Business Mailing Address
First Line	:	2404 LUCAS AND HUNT RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-5016
Country	:	US
Telephone Number	:	314-440-6607
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 LUCAS AND HUNT RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-5016
Country	:	US
Telephone Number	:	314-440-6607
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. CARLUSS MARIE JOHNSON
Credential	:
Telephone Number	:	314-440-6607

Provider Enumeration Date	:	07/15/2020
Last Update Date	:	07/15/2020

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