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NPI Code Detail

MEDICARE: A DIFFERENT WORLD IN-HOME SERVICES LLC

MEDICARE: A DIFFERENT WORLD IN-HOME 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
1253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1306368097
Entity Type Code : Organization
Provider Name (Legal Business Name) : A DIFFERENT WORLD IN-HOME SERVICES LLC
Provider Business Mailing Address
First Line : 111 CHURCH ST STE 104
Second Line :
City : FERGUSON
State : MO
Zip : 63135-2457
Country : US
Telephone Number : 314-397-1279
Fax Number : 314-736-1388
Provider Business Practice Location Address
First Line : 111 CHURCH ST STE 104
Second Line :
City : FERGUSON
State : MO
Zip : 63135-2457
Country : US
Telephone Number : 314-397-1279
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MISS DANYELLE N NELSON
Credential :
Telephone Number : 314-397-1279
Provider Enumeration Date : 07/13/2017
Last Update Date : 07/13/2017

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Directions to “A DIFFERENT WORLD IN-HOME SERVICES LLC ” Practice Location

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