MEDICARE: STAGES 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	:	1487172227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAGES LLC

Provider Business Mailing Address
First Line	:	424 CHAMBERS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63137-3702
Country	:	US
Telephone Number	:	314-498-6024
Fax Number	:	314-388-2058

Provider Business Practice Location Address
First Line	:	424 CHAMBERS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63137-3702
Country	:	US
Telephone Number	:	314-498-6024
Fax Number	:	314-388-2058

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER DEAN ROSS
Credential	:
Telephone Number	:	314-498-6024

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	08/31/2017

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