MEDICARE: ALL INCLUSIVE IN HOME SERVICE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1649930322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL INCLUSIVE IN HOME SERVICE LLC

Provider Business Mailing Address
First Line	:	9738 LACKLAND RD
Second Line	:
City	:	OVERLAND
State	:	MO
Zip	:	63114-3424
Country	:	US
Telephone Number	:	314-428-4020
Fax Number	:

Provider Business Practice Location Address
First Line	:	9738 LACKLAND RD
Second Line	:
City	:	OVERLAND
State	:	MO
Zip	:	63114-3424
Country	:	US
Telephone Number	:	314-428-4020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANA R CAREY
Credential	:
Telephone Number	:	314-428-4020

Provider Enumeration Date	:	12/22/2021
Last Update Date	:	12/22/2021

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