MEDICARE: AT EASE HOME CARE, INC.

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	251F00000X	Home Infusion Agency	00478801	MO
2	251E00000X	Home Health Agency	00478801	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255530465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT EASE HOME CARE, INC.

Provider Business Mailing Address
First Line	:	11500 OLIVE BLVD
Second Line	:	SUITE 176
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7143
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11500 OLIVE BLVD
Second Line	:	SUITE 176
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7143
Country	:	US
Telephone Number	:	314-531-5310
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	DAN FRIEDMAN
Credential	:
Telephone Number	:	314-351-3510

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	07/01/2008

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