MEDICARE: ENNOVY HEALTH AT HOME 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1427833862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENNOVY HEALTH AT HOME LLC

Provider Business Mailing Address
First Line	:	7041 BELLINGHAM CIR
Second Line	:
City	:	O FALLON
State	:	IL
Zip	:	62269-6963
Country	:	US
Telephone Number	:	636-875-3772
Fax Number	:

Provider Business Practice Location Address
First Line	:	12645 OLIVE BLVD STE 232
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6692
Country	:	US
Telephone Number	:	636-875-3772
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	RAQUEL N JONES
Credential	:
Telephone Number	:	636-875-3772

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	08/25/2023

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