MEDICARE: ROBERTA'S HEALTH CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1295281756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTA'S HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1115 WATER VIEW LN
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-1477
Country	:	US
Telephone Number	:	314-324-8721
Fax Number	:	636-294-7062

Provider Business Practice Location Address
First Line	:	1555 KISKER RD
Second Line	:	STE 126
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-0602
Country	:	US
Telephone Number	:	314-324-8721
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANGELA MICHELLE MILLER
Credential	:
Telephone Number	:	314-324-8721

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	08/25/2016

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