MEDICARE: PREDICTIVE NEEDS HEALTHCARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1376292268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREDICTIVE NEEDS HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	4633 RICHMOND FOREST DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2848
Country	:	US
Telephone Number	:	314-536-0603
Fax Number	:

Provider Business Practice Location Address
First Line	:	4633 RICHMOND FOREST DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2848
Country	:	US
Telephone Number	:	314-536-0603
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TASANYA JOHNSON
Credential	:
Telephone Number	:	314-536-0603

Provider Enumeration Date	:	03/20/2022
Last Update Date	:	03/21/2022

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