MEDICARE: ADDITIONAL IN HOME CARE, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	3747P1801X	Personal Care Attendant
3	376J00000X	Homemaker
4	372500000X	Chore Provider

General Provider Information

NPI Number	:	1689004673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDITIONAL IN HOME CARE, INC.

Provider Business Mailing Address
First Line	:	801 WOODLAWN AVE STE 29
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-7647
Country	:	US
Telephone Number	:	636-294-6324
Fax Number	:	636-294-6325

Provider Business Practice Location Address
First Line	:	801 S WOODLAWN
Second Line	:	STE. 27
City	:	O FALLON
State	:	MO
Zip	:	63366-7646
Country	:	US
Telephone Number	:	636-294-6324
Fax Number	:	866-277-3475

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. CRYSTAL LYNN DANIELS
Credential	:
Telephone Number	:	314-497-5990

Provider Enumeration Date	:	11/12/2013
Last Update Date	:	11/08/2022

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