MEDICARE: IDENTITY HOME HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251J00000X	Nursing Care Agency
2	251E00000X	Home Health Agency
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1669807756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDENTITY HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	1456 GOODFELLOW BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63112-3736
Country	:	US
Telephone Number	:	314-252-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	1456 GOODFELLOW BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63112-3736
Country	:	US
Telephone Number	:	314-252-0580
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANTHONY T MORROW SR.
Credential	:
Telephone Number	:	314-252-0580

Provider Enumeration Date	:	09/07/2013
Last Update Date	:	09/07/2013

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Directions to “IDENTITY HOME HEALTH CARE LLC ” Practice Location

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