MEDICARE: PREFERRED FAMILY HEALTH 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	324500000X	Substance Abuse Rehabilitation Facility
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1326722240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED FAMILY HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	1601 OLD SOUTH RIVER RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-4120
Country	:	US
Telephone Number	:	636-224-1210
Fax Number	:	636-246-1008

Provider Business Practice Location Address
First Line	:	115 N MADISON ST
Second Line	:
City	:	PITTSFIELD
State	:	IL
Zip	:	62363-1405
Country	:	US
Telephone Number	:	447-442-1921
Fax Number	:

Authorized Official
Title or Position	:	CHIEF REVENUE OFFICER
Name	:	MARK CONOVER
Credential	:
Telephone Number	:	573-603-1460

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/13/2023

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