MEDICARE: A PERFECT BALANCE IN HOME 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	:	1396375655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PERFECT BALANCE IN HOME SERVICES LLC

Provider Business Mailing Address
First Line	:	2335 RUTGER ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-2433
Country	:	US
Telephone Number	:	314-261-8890
Fax Number	:

Provider Business Practice Location Address
First Line	:	2335 RUTGER ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-2433
Country	:	US
Telephone Number	:	314-261-8890
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. TONIQUE BUTLER
Credential	:
Telephone Number	:	314-833-7150

Provider Enumeration Date	:	01/24/2020
Last Update Date	:	01/24/2020

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