MEDICARE: SIGNATURE FOUNDATION HOME HEALTH

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	768	MO

General Provider Information

NPI Number	:	1346236007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIGNATURE FOUNDATION HOME HEALTH

Provider Business Mailing Address
First Line	:	4850 LEMAY FERRY RD
Second Line	:	STE 101
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-1576
Country	:	US
Telephone Number	:	314-416-1990
Fax Number	:	314-416-7626

Provider Business Practice Location Address
First Line	:	4850 LEMAY FERRY RD
Second Line	:	STE 101
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-1576
Country	:	US
Telephone Number	:	314-416-1990
Fax Number	:	314-416-7626

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SUE THOMURE
Credential	:	RN MHA
Telephone Number	:	314-416-1990

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	08/22/2020

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