MEDICARE: PREFERRED FAMILY HEALTHCARE, INC.

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	251S00000X	Community/Behavioral Health Agency	1199	MO

General Provider Information

NPI Number	:	1528446986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED FAMILY HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	1601 OLD SOUTH RIVER RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-4120
Country	:	US
Telephone Number	:	636-224-1210
Fax Number	:	636-246-1008

Provider Business Practice Location Address
First Line	:	4928 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1615
Country	:	US
Telephone Number	:	314-899-0846
Fax Number	:	314-899-0869

Authorized Official
Title or Position	:	CHIEF REVENUE OFFICER
Name	:	MARK CONOVER
Credential	:
Telephone Number	:	660-665-1962

Provider Enumeration Date	:	05/18/2015
Last Update Date	:	07/29/2022

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