MEDICARE: SOAHIL HEALTH SERVICES 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	:	1275069270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOAHIL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	120 1ST CAPITOL DR
Second Line	:	STE 2
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2898
Country	:	US
Telephone Number	:	636-493-6261
Fax Number	:	636-493-6850

Provider Business Practice Location Address
First Line	:	4432 FARLIN AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-2723
Country	:	US
Telephone Number	:	314-745-0005
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOT/OWNER
Name	:	BRANDY FOWLER
Credential	:
Telephone Number	:	314-745-0005

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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