MEDICARE: ASTONISHING IN-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

General Provider Information

NPI Number	:	1235727983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASTONISHING IN-HOME CARE LLC

Provider Business Mailing Address
First Line	:	9378 OLIVE BLVD STE 104B
Second Line	:
City	:	OLIVETTE
State	:	MO
Zip	:	63132-3222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9378 OLIVE BLVD STE 104B
Second Line	:
City	:	OLIVETTE
State	:	MO
Zip	:	63132-3222
Country	:	US
Telephone Number	:	314-475-5655
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIARA TIMES
Credential	:
Telephone Number	:	314-475-5655

Provider Enumeration Date	:	01/07/2021
Last Update Date	:	01/08/2021

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Directions to “ASTONISHING IN-HOME CARE LLC ” Practice Location

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