MEDICARE: HUMBLE HAVEN 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1306422423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMBLE HAVEN CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	4669 RICHMOND FOREST DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2848
Country	:	US
Telephone Number	:	314-484-3827
Fax Number	:

Provider Business Practice Location Address
First Line	:	4669 RICHMOND FOREST DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2848
Country	:	US
Telephone Number	:	314-484-3827
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CAMILLE FOSTER
Credential	:
Telephone Number	:	314-484-3827

Provider Enumeration Date	:	03/19/2021
Last Update Date	:	07/14/2021

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