MEDICARE: HOME REMEDY ST. LOUIS 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	251S00000X	Community/Behavioral Health Agency	2014023114	MO

General Provider Information

NPI Number	:	1346625167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME REMEDY ST. LOUIS LLC

Provider Business Mailing Address
First Line	:	7710 CARONDELET AVE STE 204
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3319
Country	:	US
Telephone Number	:	314-439-1005
Fax Number	:

Provider Business Practice Location Address
First Line	:	7710 CARONDELET AVE STE 204
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3319
Country	:	US
Telephone Number	:	314-439-1005
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DAVID A WEINBERG
Credential	:	MSW, LCSW
Telephone Number	:	314-439-1005

Provider Enumeration Date	:	07/22/2015
Last Update Date	:	07/22/2015

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