MEDICARE: HELIA HEALTHCARE OF FLORISSANT, 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	314000000X	Skilled Nursing Facility	030747	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548258023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HELIA HEALTHCARE OF FLORISSANT, LLC

Provider Business Mailing Address
First Line	:	500 NW PLAZA DR STE 712
Second Line	:
City	:	SAINT ANN
State	:	MO
Zip	:	63074-2222
Country	:	US
Telephone Number	:	314-566-0459
Fax Number	:

Provider Business Practice Location Address
First Line	:	13700 OLD HALLS FERRY RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-4109
Country	:	US
Telephone Number	:	314-355-0760
Fax Number	:	314-355-8169

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	STEPHEN P MILLER
Credential	:
Telephone Number	:	312-994-2306

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	03/17/2024

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