MEDICARE: TENISHA C THORNTON

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	:	1568987279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENISHA C THORNTON

Provider Business Mailing Address
First Line	:	14812 STRATFORD CT APT B
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-1962
Country	:	US
Telephone Number	:	314-323-6803
Fax Number	:

Provider Business Practice Location Address
First Line	:	1033 CORPORATE SQUARE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2928
Country	:	US
Telephone Number	:	314-323-6803
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	08/03/2017

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Directions to “ TENISHA C THORNTON ” Practice Location

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