MEDICARE: KOREDE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	163WL0100X	Lactation Consultant (Registered Nurse)
3	174400000X	Specialist
4	174N00000X	Lactation Consultant (Non-RN)
5	175T00000X	Peer Specialist
6	176B00000X	Midwife
7	374U00000X	Home Health Aide
8	376J00000X	Homemaker
9	101YM0800X	Mental Health Counselor
10	374J00000X	Doula

General Provider Information

NPI Number	:	1396577052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOREDE INC.

Provider Business Mailing Address
First Line	:	4317 FOREST PARK AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2820
Country	:	US
Telephone Number	:	817-690-0118
Fax Number	:

Provider Business Practice Location Address
First Line	:	4317 FOREST PARK AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2820
Country	:	US
Telephone Number	:	314-266-8205
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. OLARONKE FALETI
Credential	:
Telephone Number	:	817-690-0118

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	09/19/2024

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