MEDICARE: QUALITY CARE IN HOME SERVICES, 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	251S00000X	Community/Behavioral Health Agency		MO
2	253Z00000X	In Home Supportive Care Agency		MO

General Provider Information

NPI Number	:	1568706257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY CARE IN HOME SERVICES, LLC

Provider Business Mailing Address
First Line	:	4005 HOUNDS HILL DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2017
Country	:	US
Telephone Number	:	314-831-5986
Fax Number	:

Provider Business Practice Location Address
First Line	:	4005 HOUNDS HILL DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2017
Country	:	US
Telephone Number	:	314-831-5986
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/DESIGNATED MANAGER
Name	:	MR. FRANKLIN D ALEXANDER JR.
Credential	:
Telephone Number	:	314-831-5986

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	11/19/2012

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